Clinical and Ultrasound Examination of the Leeds Enthesitis Index in Psoriatic Arthritis and Rheumatoid Arthritis

Abstract

Objective. To compare scores for the Leeds enthesitis index in psoriatic arthritis and rheumatoid arthritis using clinical assessment and ultrasonography (US). Design. Swelling and tenderness of the enthesis was assessed at six sites: lateral epicondyles of humerus (LE), medial condyles of femur (MC), and the insertion of the Achilles tendon (AT). US assessed “inflammatory activity” (power Doppler signal, oedema, tendon thickening, and bursal swelling) and “damage” (erosions and enthesophytes). Results. 94 patients were included, 71 with PsA and 23 with RA. The patients with RA were significantly older (PsA 47.6 years; RA 62.6 years; (mean difference in ages =15.0 years, 95% CI 9.3–20.7 years)). US scores were higher in RA at the LE, significantly so for the “damage” scores. No differences between RA and PsA were seen at the other sites. As a result, the odds ratio for PsA, given an US score above the median, was 0.41 (0.13–1.03). However, using the clinical score, the odds ratio for PsA was 2.16 (0.81–5.70). Conclusions. Although clinical scores of enthesitis are greater in PsA compared to RA, US enthesitis scores did not distinguish between RA and PsA. This may in part be due to more frequent juxta-articular involvement in RA and in part due to the older age of the subjects with RA.

Value of ultrasound examination of the Leeds Enthesitis Index in assessment of disease activity in psoriatic arthritis

“…Data were an alyzed using the SPSS v. 20 On the other hand the total damage score as well as the damage score at the 6-LEI points showed insignifi cant difference between the two groups.…”

The association between sonographic enthesitis and radiographic damage in psoriatic arthritis

“…However, there are studies that could not confirm the specific link between enthesitis and SpA [ 35 , 36 ]. Paramarta et al found the same prevalence of entheseal involvement in SpA and RA patients [ 35 ].…”

Symptoms dermatologists should look for in daily practice to improve detection of psoriatic arthritis in psoriasis patients: an expert group consensus

“…Swollen or painful Achille's tendon is an important sign of enthesitis and is part of the items of the Leeds Enthesitis Index and the EARP questionnaire …”