Ultrasound scoring scales used in the assessment of enthesitis.
| Index Name/Scoring System | Originally Devised for | No. Sites Examined | Sites Examined | Features | Imaging Modality |
|---|---|---|---|---|---|
| OMERACT Ultrasound Working Group19 | SpA and PsA | 4 (3 lower limbs, 1 upper body) | Superior and inferior poles of the patella, calcaneal insertion of Achilles tendon; lateral condyle of the elbow | Developed to monitor changes in inflammatory lesions following treatment Evaluates global enthesis involvement in an individual patient Each enthesis evaluated (yes/no basis) for 7 elementary components (hypoechogenicity, increased thickness, enthesophyte, calcification, bone erosion, bone irregularity, and PD) Next steps will be to weigh the different inflammatory components and test their sensitivity to change | Greyscale and PD |
| The GRAPPA Ultrasound Working Group20,24 | PsA | 6 (4 lower limbs, 2 upper body) | Patellar ligament insertions into distal patella and tibial tuberosity, Achilles tendon, plantar fascia; supraspinatus, lateral epicondyle | Developed to allow for early diagnosis of PsA Evaluates global enthesis involvement in an individual patient Assesses 5 elementary lesions (hypoechogenicity, thickening, enthesophyte, erosions, and Doppler signal) of 6 entheseal sites Identified 6 entheseal sites important for distinguishing patients with PsA from those without the disease: patellar ligament insertions into the distal patella and tibial tuberosity, Achilles tendon and plantar fascia insertions into the calcaneus, common extensor tendon insertion into the lateral epicondyle, and supraspinatus insertion into the superior facet of the humerusAims to distinguish patients with PsA from age- and sex-matched healthy controls, and monitor response to treatment | Greyscale and PD |
| Glasgow Ultrasound Enthesis Scoring System2,21,25 | SpA | 5 (lower limb only) | Quadriceps tendon, patellar ligament (proximal and distal), Achilles tendon, plantar aponeurosis | Developed for diagnosis of SpA Assesses 18 features of 5 entheses – grading individual enthesis involvement First scoring system to be published (2002) | Greyscale |
| Sonographic Enthesitis Index26 | AS | 5 (lower limb only) | Quadriceps tendon, patellar tendon (proximal and distal), Achilles tendon, plantar aponeurosis | Developed for monitoring disease activity and enthesealresponse to treatment Evaluates global enthesis involvement in an individual patient Differentiates between inflammatory and structural damage Does not differentiate between involvement of enthesis, body of tendon, and bursa | Greyscale |
| Madrid Sonographic Enthesitis Index21,27 | SpA | 6 (5 lower limbs, 1 upper body) | Quadriceps tendon, patellar tendon (distal and proximal), Achilles tendon, proximal plantar fascia, distal triceps tendon | Developed for the diagnosis of SpA Evaluates global enthesis involvement in an individual patient Scores calcifications, bursae, erosions, PD signal, and thickness and structure | Greyscaleand PD |
| D’Agostino, et al28 | SpA | 9 (lower body entheses) | Greater trochanter, pubis, quadriceps tendon, patellar tendon, tibialis anterior tendon, Achilles tendon, plantaris fascia, lateral epicondyle, medial epicondyle | Developed for diagnosis of SpA 5 stages to grade individual enthesis involvement Differentiates between early enthesitis, morphological alterations, and inactive lesions | Greyscale and PD |
AS: ankylosing spondylitis; GRAPPA: Group for Research and Assessment of Psoriasis and Psoriatic Arthritis; MRI: magnetic resonance imaging; OMERACT: Outcome Measures in Rheumatology; PD: power Doppler; PsA: psoriatic arthritis; SpA: spondyloarthritis; US: ultrasound.