Research article

Arthritis Research & Therapy

, 13:R188

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Ultrasound in the evaluation of enthesitis: status and perspectives

  • Frédérique GandjbakhchAffiliated withRheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, APHP
  • , Lene TerslevAffiliated withRheumatology Department, Copenhagen University Hospital at Glostrup
  • , Fredrick JoshuaAffiliated withRheumatology Department, Prince of Wales Hospital
  • , Richard J WakefieldAffiliated withSection of Musculoskeletal Disease, LIMM, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research
  • , Esperanza NaredoAffiliated withRheumatology Department, Hospital Universitario Severo Ochoa
  • , Maria Antonietta D’AgostinoAffiliated withRheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, APHP, UPRES EA 2506 Email author 
  • , OMERACT Ultrasound Task Force



An increasing number of studies have applied ultrasound to the evaluation of entheses in spondyloarthritis patients. However, no clear agreement exists on the definition of enthesitis, on the number and choice of entheses to examine and on ultrasound technique, which may all affect the results of the examination. The objectives of this study were to first determine the level of homogeneity in the ultrasound definitions for the principal lesions of enthesitis in the published literature and second, to evaluate the metric properties of ultrasound for detecting enthesitis according to the OMERACT filter.


Search was performed in PUBMED and EMBASE. Both grey-scale and Doppler definitions of enthesitis, including describing features of enthesitis, were collected and metrological qualities of studies were assessed.


After selection, 48 articles were analyzed. The definition of ultrasound enthesitis and elementary features varied among authors. Grey-scale enthesitis was characterized by increasing thickness (94% of studies), hypoechogenicity (83%), enthesophytes (69%), erosions (67%), calcifications (52%), associated bursitis (46%) and cortical irregularities (29%). Only 46% of studies reported the use of Doppler. High discrepancies were observed on frequency, type of probe and Doppler mode used. Face and content validity were the most frequently evaluated criteria (43%) followed by reliability (29%) and responsiveness (19%).


Ultrasound has evidence to support face, content validity and reliability for the evaluation of enthesitis, though there is a lack of well-reported methodology in most of the studies. Consensus on elementary lesions and standardization of exam is needed to determine the ultrasound definition of enthesitis in grey-scale and in Doppler for future applications.


Systematic literature review scoring system ultrasound power Doppler enthesitis enthesopathy spondyloarthritis ankylosing spondylitis OMERACT filter