{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:50:45Z","timestamp":1792043445062,"version":"4.4.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T00:00:00Z","timestamp":1686182400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T00:00:00Z","timestamp":1686182400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthritis Res Ther"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>In axial spondyloarthritis (axSpA), peripheral SpA (pSpA) and psoriatic arthritis (PsA), enthesitis is a hallmark clinical feature that can be assessed by the SPARCC index, LEI, MASES and MEI. These indices evaluate different locations, which may identify different numbers of patients with enthesitis among SpA subtypes. Thus, the aim of this study was to evaluate whether the proportion of patients with at least one enthesitis across these three most prevalent SpA subtypes differs according to the index used and to evaluate the level of agreement among indices in detecting patients with enthesitis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A total of 4185 patients (2719 axSpA, 433 pSpA and 1033 PsA) from the international and cross-sectional ASAS-PerSpA study were included. The proportion of patients with enthesitis identified by the indices was evaluated across the three diseases. Pairwise agreement between indices was computed using Cohen\u2019s kappa.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The prevalence rates of patients with at least one enthesitis according to the MEI, MASES, SPARCC index and LEI were 17.2%, 13.5%, 10.7%, and 8.3%, respectively. In axSpA, the indices that identified the most patients with enthesitis were the MEI and MASES (98.7% and 82.4%, respectively); in pSpA and PsA, the indices that identified the most patients with enthesitis were the MEI and SPARCC index (MEI: 100% and SPARCC: 84.6%; MEI: 97.3% and SPARCC: 77%, respectively). In the total population, the MASES vs. MEI showed the strongest agreement (absolute agreement 96.3%; kappa: 0.86); similar results were obtained in axSpA patients (97.3%; 0.90). In pSpA and PsA patients, the SPARCC vs. MEI (97.2%; 0.90 and 95.4%; 0.83, respectively) showed the strongest agreement.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>These results suggest that the prevalence of patients with enthesitis across SpA subtypes differs depending on the disease and the index used. The MEI and MASES appeared best for assessing enthesis in SpA and axSpA, while the MEI and SPARCC index appeared best for assessing enthesitis in pSpA and PsA.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13075-023-03080-0","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T08:01:43Z","timestamp":1686211303000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Enthesitis indices identify different patients with this characteristic in axial and peripheral spondyloarthritis and also in psoriatic arthritis: ASAS-PerSpA data"],"prefix":"10.1186","volume":"25","author":[{"given":"Raquel Ena Mar\u00eda","family":"Granados","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3890-2224","authenticated-orcid":false,"given":"M. Lourdes","family":"Ladehesa-Pineda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. \u00c1ngeles","family":"Puche-Larrubia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Escudero-Contreras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Dougados","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Collantes-Estevez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clementina","family":"L\u00f3pez-Medina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,8]]},"reference":[{"issue":"6","key":"3080_CR1","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1136\/ard.2009.108233","volume":"68","author":"M Rudwaleit","year":"2009","unstructured":"Rudwaleit M, van der Heijde D, Landew\u00e9 R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777\u201383.","journal-title":"Ann Rheum Dis"},{"issue":"1","key":"3080_CR2","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1136\/ard.2010.133645","volume":"70","author":"M Rudwaleit","year":"2010","unstructured":"Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, et al. The assessment of spondyloarthritis international society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2010;70(1):25\u201331.","journal-title":"Ann Rheum Dis"},{"issue":"3","key":"3080_CR3","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2021-001728","volume":"7","author":"C L\u00f3pez-Medina","year":"2021","unstructured":"L\u00f3pez-Medina C, Chevret S, Molto A, Sieper J, Duru\u00f6z T, Kiltz U, et al. Identification of clinical phenotypes of peripheral involvement in patients with spondyloarthritis, including psoriatic arthritis: a cluster analysis in the worldwide ASAS-PerSpA study. RMD Open. 2021;7(3): e001728.","journal-title":"RMD Open"},{"issue":"1","key":"3080_CR4","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.semarthrit.2017.12.008","volume":"48","author":"GS Kaeley","year":"2018","unstructured":"Kaeley GS, Eder L, Aydin SZ, Gutierrez M, Bakewell C. Enthesitis: A hallmark of psoriatic arthritis. Semin Arthritis Rheum. 2018;48(1):35\u201343.","journal-title":"Semin Arthritis Rheum"},{"issue":"1","key":"3080_CR5","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2020-001450","volume":"7","author":"C L\u00f3pez-Medina","year":"2021","unstructured":"L\u00f3pez-Medina C, Molto A, Sieper J, Duru\u00f6z T, Kiltz U, Elzorkany B, et al. Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study. RMD Open. 2021;7(1): e001450.","journal-title":"RMD Open"},{"issue":"12","key":"3080_CR6","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\u2019Agostino M-A, 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":"1","key":"3080_CR7","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":"3","key":"3080_CR8","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1136\/ard.46.3.197","volume":"46","author":"M Mander","year":"1987","unstructured":"Mander M, Simpson JM, McLellan A, Walker D, Goodacre JA, Dick WC. Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis. Ann Rheum Dis. 1987;46(3):197\u2013202.","journal-title":"Ann Rheum Dis"},{"issue":"6","key":"3080_CR9","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1136\/ard.2007.084244","volume":"68","author":"WP Maksymowych","year":"2008","unstructured":"Maksymowych WP, Mallon C, Morrow S, Shojania K, Olszynski WP, Wong RL, et al. Development and validation of the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index. Ann Rheum Dis. 2008;68(6):948\u201353.","journal-title":"Ann Rheum Dis"},{"issue":"5","key":"3080_CR10","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1002\/art.23568","volume":"59","author":"PJ Healy","year":"2008","unstructured":"Healy PJ, Helliwell PS. Measuring clinical enthesitis in psoriatic arthritis: Assessment of existing measures and development of an instrument specific to psoriatic arthritis. Arthritis Rheum. 2008;59(5):686\u201391.","journal-title":"Arthritis Rheum"},{"issue":"2","key":"3080_CR11","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1136\/ard.62.2.127","volume":"62","author":"L Heuft-Dorenbosch","year":"2003","unstructured":"Heuft-Dorenbosch L. Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis. 2003;62(2):127\u201332.","journal-title":"Ann Rheum Dis"},{"issue":"6","key":"3080_CR12","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1136\/annrheumdis-2015-208593","volume":"75","author":"L Gossec","year":"2016","unstructured":"Gossec L, Portier A, Landew\u00e9 R, Etcheto A, Navarro-Comp\u00e1n V, Kroon F, et al. Preliminary definitions of \u201cflare\u201d in axial spondyloarthritis, based on pain, BASDAI and ASDAS-CRP: an ASAS initiative. Ann Rheum Dis. 2016;75(6):991\u20136.","journal-title":"Ann Rheum Dis"},{"issue":"S11","key":"3080_CR13","doi-asserted-by":"publisher","first-page":"S47","DOI":"10.1002\/acr.20575","volume":"63","author":"J Zochling","year":"2011","unstructured":"Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Sp. Arthritis Care Res. 2011;63(S11):S47-58.","journal-title":"Arthritis Care Res"},{"issue":"12","key":"3080_CR14","first-page":"2281","volume":"21","author":"A Calin","year":"1994","unstructured":"Calin A, Garrett S, Whitelock H, Kennedy LG, O\u2019Hea J, Mallorie P, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994;21(12):2281\u20135.","journal-title":"J Rheumatol"},{"key":"3080_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2021.12.012","volume":"52","author":"AJ Mathew","year":"2022","unstructured":"Mathew AJ, Glintborg B, Krogh NS, Hetland ML, \u00d8stergaard M. Enthesitis in patients with psoriatic arthritis and axial spondyloarthritis \u2013 data from the Danish nationwide DANBIO registry. Semin Arthritis Rheum. 2022;52: 151948.","journal-title":"Semin Arthritis Rheum"},{"issue":"11","key":"3080_CR16","doi-asserted-by":"publisher","first-page":"1685","DOI":"10.1002\/acr.23174","volume":"69","author":"A Polachek","year":"2017","unstructured":"Polachek A, Li S, Chandran V, Gladman DD. Clinical Enthesitis in a Prospective Longitudinal Psoriatic Arthritis Cohort: Incidence, Prevalence, Characteristics, and Outcome. Arthritis Care Res. 2017;69(11):1685\u201391.","journal-title":"Arthritis Care Res"},{"key":"3080_CR17","doi-asserted-by":"crossref","unstructured":"Behrens F, Sewerin P, de Miguel E, Patel Y, Batalov A, Dokoupilova E, et al. Efficacy and safety of secukinumab in patients with spondyloarthritis and enthesitis at the Achilles tendon: results from a phase 3b trial. Rheumatology (Oxford). 2022;61(7):2856-66.","DOI":"10.1093\/rheumatology\/keab784"},{"issue":"5","key":"3080_CR18","first-page":"376","volume":"51","author":"J Zhang","year":"2012","unstructured":"Zhang J, Huang F, Zhang J-L, Zhang H, Zhang Y-M. The efficacy of etanercept in enthesitis in ankylosing spondylitis and an evaluation method for enthesitis. Zhonghua Nei Ke Za Zhi. 2012;51(5):376\u20139.","journal-title":"Zhonghua Nei Ke Za Zhi"},{"issue":"2","key":"3080_CR19","doi-asserted-by":"publisher","first-page":"R43","DOI":"10.1186\/ar2953","volume":"12","author":"M Rudwaleit","year":"2010","unstructured":"Rudwaleit M, Claudepierre P, Kron M, Kary S, Wong R, Kupper H. Effectiveness of adalimumab in treating patients with ankylosing spondylitis associated with enthesitis and peripheral arthritis. Arthritis Res Ther. 2010;12(2):R43.","journal-title":"Arthritis Res Ther"},{"issue":"11","key":"3080_CR20","doi-asserted-by":"publisher","first-page":"5337","DOI":"10.1093\/rheumatology\/keab285","volume":"60","author":"D McGonagle","year":"2021","unstructured":"McGonagle D, McInnes IB, Deodhar A, Schett G, Shawi M, Kafka S, et al. Resolution of enthesitis by guselkumab and relationships to disease burden: 1-year results of two phase 3 psoriatic arthritis studies. Rheumatology. 2021;60(11):5337\u201350.","journal-title":"Rheumatology"},{"key":"3080_CR21","doi-asserted-by":"crossref","unstructured":"Gladman DD, Orbai A-M, Klitz U, Wei JC-C, Gallo G, Birt J, et al. Ixekizumab and complete resolution of enthesitis and dactylitis: integrated analysis of two phase 3 randomized trials in psoriatic arthritis. Arthritis Res Ter. 2019;21(1):38.","DOI":"10.1186\/s13075-019-1831-0"},{"issue":"5","key":"3080_CR22","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1093\/rheumatology\/key369","volume":"58","author":"SK Appani","year":"2018","unstructured":"Appani SK, Devarasetti PK, Irlapati RVP, Rajasekhar L. Methotrexate achieves major cDAPSA response, and improvement in dactylitis and functional status in psoriatic arthritis. Rheumatology. 2018;58(5):869\u201373.","journal-title":"Rheumatology"},{"issue":"3","key":"3080_CR23","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1093\/rheumatology\/keab449","volume":"61","author":"AF Wells","year":"2021","unstructured":"Wells AF, Edwards CJ, Kivitz AJ, Bird P, Guerette B, Delev N, et al. Apremilast monotherapy for long-term treatment of active psoriatic arthritis in DMARD-na\u00efve patients. Rheumatology. 2021;61(3):1035\u201343.","journal-title":"Rheumatology"},{"key":"3080_CR24","doi-asserted-by":"crossref","unstructured":"Kavanaugh A, Gladman DD, Edwards CJ, Schett G, Guerette B, Delev N, et al. Long-term experience with apremilast in patients with psoriatic arthritis: 5-year results from a PALACE 1\u20133 pooled analysis. Arthritis Res Ter. 2019;21(1):118.","DOI":"10.1186\/s13075-019-1901-3"},{"issue":"11","key":"3080_CR25","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.3899\/jrheum.180792","volume":"46","author":"IB McInnes","year":"2019","unstructured":"McInnes IB, Puig L, Gottlieb AB, Ritchlin CT, Song M, You Y, et al. Association Between enthesitis and health-related quality of life in psoriatic arthritis in biologic-naive patients from 2 Phase III Ustekinumab Trials. J Rheumatol. 2019;46(11):1458\u201361.","journal-title":"J Rheumatol"},{"key":"3080_CR26","doi-asserted-by":"publisher","unstructured":"Hamitouche F, Lopez-Medina C, Gossec L, Perrot S, Dougados M, Molt\u00f3 A. Evaluation of the agreement between the ACR 1990 fibromyalgia tender points and an enthesitis score in patients with axial spondyloarthritis. Rheumatology 2022 published on 27 December 2022. doi.org\/https:\/\/doi.org\/10.1093\/rheumatology\/keac683.","DOI":"10.1093\/rheumatology\/keac683"}],"container-title":["Arthritis Research &amp; Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13075-023-03080-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13075-023-03080-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13075-023-03080-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T08:05:15Z","timestamp":1686211515000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthritis-research.biomedcentral.com\/articles\/10.1186\/s13075-023-03080-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,8]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["3080"],"URL":"https:\/\/doi.org\/10.1186\/s13075-023-03080-0","relation":{},"ISSN":["1478-6362"],"issn-type":[{"value":"1478-6362","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,8]]},"assertion":[{"value":"10 February 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 May 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 June 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study complied with the ethics requirements. The data were obtained from the ASAS-perSpA study, which was conducted according to the guidelines for Good Clinical Practice and was approved by the ethics committees in all countries. Additionally, written informed consent was obtained from the subjects.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"99"}}