{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:18:29Z","timestamp":1772165909004,"version":"3.50.1"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,11,21]],"date-time":"2020-11-21T00:00:00Z","timestamp":1605916800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,11,21]],"date-time":"2020-11-21T00:00:00Z","timestamp":1605916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004336","name":"Novartis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004336","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The currently available scoring methods for enthesitis are often measures of pain but not of inflammation at entheseal sites. The Outcome Measures in Rheumatology Clinical Trials (OMERACT) psoriatic arthritis (PsA) magnetic resonance imaging (MRI) scoring system (PsAMRIS) assesses inflammation and damage in PsA and was particularly developed for the hands. The ACHILLES trial used clinical measures for heel enthesitis in combination with MRI scoring based on PsAMRIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients (age\u2009\u2265\u200918\u2009years) with spondyloarthritis (SpA) and PsA were included in the trial if they presented with clinical and MRI-positive heel enthesitis. MRI of the affected heel was performed at three time points: screening, Week 24 and Week 52. Inflammatory MRI findings (tendinitis, bursitis and bone marrow oedema [BME]) in the area of the Achilles tendon and\/or plantar aponeurosis, periarticular inflammation of the ankle joint and heel erosion were assessed qualitatively (absent\/present). In addition, BME and bone erosion were quantitatively assessed based on PsAMRIS, where their proportion was compared to the volume of the affected bone. Mean scores of BME and bone erosion quantification were calculated, and the mean composite score (based on PsAMRIS) was calculated based on the individual score of each subject for periarticular inflammation, BME and bone erosion and further extended for bursitis and tendinitis. Modifications to PsAMRIS were introduced by categorising oedema length as \u2264\/&gt;\u20090.5\u2009cm and locating bone erosion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In ACHILLES, MRI was used to assess and evaluate heel enthesitis. Due to the lack of a validated scoring system for heel enthesitis at the time of ACHILLES initiation, this trial applied quantitative scoring based on PsAMRIS, with specific adaptations for the heel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      National Clinical Trial Registry,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02771210\">NCT02771210<\/jats:ext-link>\n                      . Registered 13 May 2016.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12891-020-03775-4","type":"journal-article","created":{"date-parts":[[2020,11,21]],"date-time":"2020-11-21T09:02:52Z","timestamp":1605949372000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Achilles tendon enthesitis evaluated by MRI assessments in patients with axial spondyloarthritis and psoriatic arthritis: a report of the methodology of the ACHILLES trial"],"prefix":"10.1186","volume":"21","author":[{"given":"Xenofon","family":"Baraliakos","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Sewerin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugenio","family":"de Miguel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Effie","family":"Pournara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Kleinmond","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette","family":"Wiedon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Behrens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,11,21]]},"reference":[{"issue":"12","key":"3775_CR1","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1038\/nrrheum.2017.188","volume":"13","author":"G Schett","year":"2017","unstructured":"Schett G, Lories RJ, D'Agostino MA, Elewaut D, Kirkham B, Soriano ER, et al. Enthesitis: from pathophysiology to treatment. Nat Rev Rheumatol. 2017;13(12):731\u201341.","journal-title":"Nat Rev Rheumatol"},{"issue":"2","key":"3775_CR2","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1002\/art.39458","volume":"68","author":"AS Kehl","year":"2016","unstructured":"Kehl AS, Corr M, Weisman MH. Review: Enthesitis: new insights into pathogenesis, diagnostic modalities, and treatment. Arthritis Rheumatol. 2016;68(2):312\u201322.","journal-title":"Arthritis Rheumatol"},{"issue":"3","key":"3775_CR3","first-page":"472","volume":"38","author":"A Di Matteo","year":"2020","unstructured":"Di Matteo A, Filippucci E, Cipolletta E, Martire V, Jesus D, Musca A, et al. How normal is the enthesis by ultrasound in healthy subjects? Clin Exp Rheumatol. 2020;38(3):472\u201378.","journal-title":"Clin Exp Rheumatol."},{"issue":"1","key":"3775_CR4","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s42358-019-0066-8","volume":"59","author":"PE Palominos","year":"2019","unstructured":"Palominos PE, de Campos APB, Ribeiro SLE, Xavier RM, Xavier JW, de Oliveira FB, et al. Correlation of enthesitis indices with disease activity and function in axial and peripheral spondyloarthritis: a cross-sectional study comparing MASES, SPARCC and LEI. Adv Rheumatol. 2019;59(1):23.","journal-title":"Adv Rheumatol"},{"issue":"5","key":"3775_CR5","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1136\/annrheumdis-2013-204239","volume":"74","author":"RP Poggenborg","year":"2015","unstructured":"Poggenborg RP, Eshed I, Ostergaard M, Sorensen IJ, Moller JM, Madsen OR, et al. Enthesitis in patients with psoriatic arthritis, axial spondyloarthritis and healthy subjects assessed by \u2018head-to-toe\u2019 whole-body MRI and clinical examination. Ann Rheum Dis. 2015;74(5):823\u20139.","journal-title":"Ann Rheum Dis"},{"issue":"8","key":"3775_CR6","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.3899\/jrheum.090352","volume":"36","author":"M Ostergaard","year":"2009","unstructured":"Ostergaard M, McQueen F, Wiell C, Bird P, Boyesen P, Ejbjerg B, et al. The OMERACT psoriatic arthritis magnetic resonance imaging scoring system (PsAMRIS): definitions of key pathologies, suggested MRI sequences, and preliminary scoring system for PsA hands. J Rheumatol. 2009;36(8):1816\u201324.","journal-title":"J Rheumatol"},{"issue":"12","key":"3775_CR7","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1111\/1346-8138.13014","volume":"42","author":"K Yanaba","year":"2015","unstructured":"Yanaba K, Sadaoka A, Yonenaga T, Saeki H, Umezawa Y, Tojo S, et al. Adalimumab markedly improves enthesitis in patients with psoriatic arthritis: evaluation with a magnetic resonance imaging scoring system. J Dermatol. 2015;42(12):1153\u20139.","journal-title":"J Dermatol"},{"issue":"Suppl 11","key":"3775_CR8","doi-asserted-by":"publisher","first-page":"S64","DOI":"10.1002\/acr.20577","volume":"63","author":"PJ Mease","year":"2011","unstructured":"Mease PJ. Measures of psoriatic arthritis: Tender and swollen joint assessment, Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Modified Nail Psoriasis Severity Index (mNAPSI), Mander\/Newcastle Enthesitis Index (MEI), Leeds Enthesitis Index (LEI), Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht Ankylosing Spondylitis Enthesis Score (MASES), Leeds Dactylitis Index (LDI), Patient Global for Psoriatic Arthritis, Dermatology Life Quality Index (DLQI), Psoriatic Arthritis Quality of Life (PsAQOL), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Psoriatic Arthritis Response Criteria (PsARC), Psoriatic Arthritis Joint Activity Index (PsAJAI), Disease Activity in Psoriatic Arthritis (DAPSA), and Composite Psoriatic Disease Activity Index (CPDAI). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S64\u201385.","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"2","key":"3775_CR9","doi-asserted-by":"publisher","first-page":"241","DOI":"10.32098\/mltj.02.2016.12","volume":"6","author":"S Kristensen","year":"2016","unstructured":"Kristensen S, Christensen JH, Schmidt EB, Olesen JL, Johansen MB, Arvesen KB, et al. Assessment of enthesitis in patients with psoriatic arthritis using clinical examination and ultrasound. Muscles Ligaments Tendons J. 2016;6(2):241\u20137.","journal-title":"Muscles Ligaments Tendons J"},{"issue":"9","key":"3775_CR10","doi-asserted-by":"publisher","first-page":"2694","DOI":"10.1002\/art.23755","volume":"58","author":"D McGonagle","year":"2008","unstructured":"McGonagle D, Wakefield RJ, Tan AL, D'Agostino MA, Toumi H, Hayashi K, et al. Distinct topography of erosion and new bone formation in achilles tendon enthesitis: implications for understanding the link between inflammation and bone formation in spondylarthritis. Arthritis Rheum. 2008;58(9):2694\u20139.","journal-title":"Arthritis Rheum"},{"key":"3775_CR11","first-page":"2046","volume":"78","author":"M Ostergaard","year":"2019","unstructured":"Ostergaard M, Maksymowych WP, Boesen M, Kubassova O, Nakasato P, Guerette B, et al. A phase IV, multicenter, single-arm, open-label study to evaluate the impact of Apremilast on hand and whole-body MRI outcomes in patients with psoriatic arthritis (MOSAIC): rationale, design and methods. Ann Rheum Dis. 2019;78:2046.","journal-title":"Ann Rheum Dis"},{"issue":"9","key":"3775_CR12","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.3899\/jrheum.181093","volume":"46","author":"AJ Mathew","year":"2019","unstructured":"Mathew AJ, Krabbe S, Eshed I, Gandjbakhch F, Bird P, Pedersen SJ, et al. The OMERACT MRI in Enthesitis initiative: definitions of key pathologies, suggested MRI sequences, and a novel heel enthesitis scoring system. J Rheumatol. 2019;46(9):1232\u20138.","journal-title":"J Rheumatol"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-020-03775-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12891-020-03775-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-020-03775-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,21]],"date-time":"2020-11-21T09:03:29Z","timestamp":1605949409000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmusculoskeletdisord.biomedcentral.com\/articles\/10.1186\/s12891-020-03775-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,21]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["3775"],"URL":"https:\/\/doi.org\/10.1186\/s12891-020-03775-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-33680\/v2","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-33680\/v1","asserted-by":"object"}]},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,21]]},"assertion":[{"value":"3 June 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 November 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 November 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors provide their consent for publication of this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"XB received grant\/research support from: AbbVie, Novartis, Consultant for: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB. PS received grant\/research support from: AbbVie, Celgene, Chugai, Janssen-Cilag, Lilly, Novartis, Pfizer, UCB; Consultant for: AbbVie, Biogen, BMS, Celgene, Chugai, Hexal, Janssen-Cilag, Lilly, Novartis, Pfizer, Roche, Sanofi-Genzyme, Swedish Orphan Biovitrum, UCB; Speakers bureau: AbbVie, Biogen, BMS, Celgene, Chugai, Hexal, Janssen-Cilag, Lilly, Novartis, Pfizer, Roche, Sanofi-Genzyme, Swedish Orphan Biovitrum, UCB. EDM received grant\/research support from: AbbVie, Novartis, Pfizer; Consultant for: AbbVie, Novartis, Pfizer; Speakers bureau: AbbVie, BMS, MSD, Novartis, Pfizer, UCB, Roche. EP is an employee of Novartis. CK is an employee of ClinProject GmbH, Eurasburg, Germany and consultant for Novartis. AW is an employee of Novartis. FB received grant\/research support from AbbVie, Pfizer, Roche, Chugai, Janssen, Novartis and consultancies\/speakers fee from AbbVie, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Sanofi, Genzyme, Lilly, Boehringer, Galapagos.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"767"}}