{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:12:20Z","timestamp":1779358340813,"version":"3.51.4"},"reference-count":82,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Musculoskeletal ultrasound (MSUS) is a well-established and reliable tool for the evaluation of entheses and enthesitis, particularly at larger and accessible sites. Recent technological advances, including high- and ultra-high-frequency transducers, have expanded its potential, enabling detailed assessment of distal extremity entheses. This narrative review provides a focused and updated perspective on this evolving field, highlighting three key advances. First, the identification and characterization of previously underrecognized entheseal sites in the distal extremities, such as pulley systems, retinacula, novel tendon insertions, and collateral ligaments, broadening the morphological spectrum of entheseal imaging. This is complemented by improved evaluation of vascularization through microvascular imaging and contrast-enhanced US (CEUS). Second, the emergence of interventional approaches, particularly US-guided entheseal biopsy, offers a novel means to investigate entheseal tissue in vivo and may establish a link between imaging and histopathology. Third, the integration of advanced functional imaging modalities, including elastography and multispectral optoacoustic tomography (MSOT), provides preliminary additional insights into the biomechanical and molecular properties of the enthesis beyond conventional structural assessment. Collectively, these developments support new investigational perspectives, positioning MSUS as a dynamic and integrative modality capable of exploring new anatomical territories and biological dimensions, with the potential to reshape the understanding and evaluation of entheseal involvement in rheumatology.<\/jats:p>","DOI":"10.3390\/jcm15103753","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T16:26:37Z","timestamp":1778689597000},"page":"3753","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Invisible to Visible: Cutting-Edge Ultrasound Insights into Entheses of the Distal Extremities in Rheumatology"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5460-864X","authenticated-orcid":false,"given":"Luis","family":"Coronel","sequence":"first","affiliation":[{"name":"Rheumatology Unit, Image and Techniques Section, Vall d\u00b4Hebron Hospital Universitari, Vall d\u00b4Hebron Barcelona Campus, 08035 Barcelona, Spain"},{"name":"Instituto Poal de Reumatologia, 08022 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4838-5854","authenticated-orcid":false,"given":"Chiara","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Instituto Poal de Reumatologia, 08022 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7702-1625","authenticated-orcid":false,"given":"Juan Jos\u00e9","family":"de Agustin","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Image and Techniques Section, Vall d\u00b4Hebron Hospital Universitari, Vall d\u00b4Hebron Barcelona Campus, 08035 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Bong","sequence":"additional","affiliation":[{"name":"Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics (Campus of Bellvitge), University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1359-1543","authenticated-orcid":false,"given":"Maribel","family":"Miguel-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics (Campus of Bellvitge), University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Alivernini","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Division of Rheumatology, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8193-9471","authenticated-orcid":false,"given":"Lene","family":"Terslev","sequence":"additional","affiliation":[{"name":"Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, 2600 Glostrup, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Antonietta","family":"D\u2019Agostino","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Division of Rheumatology, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9225-2568","authenticated-orcid":false,"given":"Ingrid","family":"M\u00f6ller","sequence":"additional","affiliation":[{"name":"Instituto Poal de Reumatologia, 08022 Barcelona, Spain"},{"name":"Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics (Campus of Bellvitge), University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1111\/j.1469-7580.2006.00540.x","article-title":"Where tendons and ligaments meet bone: Attachment sites (\u2018entheses\u2019) in relation to exercise and\/or mechanical load","volume":"208","author":"Benjamin","year":"2006","journal-title":"J. Anat."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/S1095-6433(02)00138-1","article-title":"The skeletal attachment of tendons\u2014Tendon \u201centheses\u201d","volume":"133","author":"Benjamin","year":"2002","journal-title":"Comp. Biochem. Physiol. Part A Mol. Integr. Physiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1111\/j.1600-0838.2009.00906.x","article-title":"Entheses: Tendon and ligament attachment sites","volume":"19","author":"Benjamin","year":"2009","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/978-1-4419-0298-6_4","article-title":"The enthesis organ concept and its relevance to the spondyloarthropathies","volume":"649","author":"Benjamin","year":"2009","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1002\/art.1780010602","article-title":"The relationship to rheumatoid arthritis of its so-called variants","volume":"1","author":"McEwen","year":"1958","journal-title":"Arthritis Rheum."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1136\/ard.30.3.213","article-title":"Enthesopathy of rheumatoid and ankylosing spondylitis","volume":"30","author":"Ball","year":"1971","journal-title":"Ann. Rheum. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"104014","DOI":"10.1016\/j.autrev.2026.104014","article-title":"Enthesitis in Spondyloarthritis. From pathogenesis to clinical presentation and imaging: Similarities and differences between PsA and axSpA","volume":"25","author":"Xynogalas","year":"2026","journal-title":"Autoimmun. Rev."},{"key":"ref_8","first-page":"85","article-title":"Criteria of the classification of spondylarthropathies","volume":"57","author":"Amor","year":"1990","journal-title":"Rev. Rhum. Mal. Osteoartic."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1002\/art.1780341003","article-title":"The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy","volume":"34","author":"Dougados","year":"1991","journal-title":"Arthritis Rheum."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1046\/j.1469-7580.2001.19950503.x","article-title":"The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites","volume":"199","author":"Benjamin","year":"2001","journal-title":"J. Anat."},{"key":"ref_11","first-page":"127","article-title":"Enthesitis detection by ultrasound: Where are we now?","volume":"36","year":"2018","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A scale for the quality assessment of narrative review articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_13","first-page":"143","article-title":"Sonographic analysis of enthesopathy in the lower extremities of patients with spondylarthropathy","volume":"12","author":"Lehtinen","year":"1994","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1136\/annrheumdis-2014-205839","article-title":"High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis","volume":"74","author":"Tan","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_15","first-page":"625","article-title":"Fibrocartilage associated with human tendons and their pulleys","volume":"187","author":"Benjamin","year":"1995","journal-title":"J. Anat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1136\/annrheumdis-2017-212681","article-title":"\u2018Deep Koebner\u2019 phenomenon of the flexor tendon-associated accessory pulleys as a novel factor in tenosynovitis and dactylitis in psoriatic arthritis","volume":"77","author":"Tinazzi","year":"2018","journal-title":"Ann. Rheum. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"183","DOI":"10.14366\/usg.22130","article-title":"Top applications of dermatologic ultrasonography that can modify management","volume":"42","author":"Wortsman","year":"2023","journal-title":"Ultrasonography"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.1007\/s11547-025-02086-9","article-title":"The evaluation of effectiveness of IL-17 and IL-23 inhibitors on nail and enthesis involvement in early psoriatic arthritis patients by high-frequency ultrasonography: A single-centre prospective proof-of-concept study","volume":"130","author":"Ruscitti","year":"2025","journal-title":"Radiol. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3321","DOI":"10.1002\/jum.15026","article-title":"Ultrasound Features of Ankle Retinacula: Normal Appearance and Pathologic Findings","volume":"38","author":"Bianchi","year":"2019","journal-title":"J. Ultrasound Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Polido-Pereira, J., Ant\u00f3nio, M.S., Khmelinskii, N., Arese, M., Teixeira, R., Vieira-Sousa, E., D\u2019Agostino, M.A., and Fonseca, J.E. (2024). Contrast-enhanced ultrasound as a valuable tool to detect minimal inflammation in RA patients in sustained remission. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1459802"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1136\/annrheumdis-2017-211585","article-title":"The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology","volume":"76","author":"Janta","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1136\/ard.61.10.905","article-title":"Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy","volume":"61","author":"Balint","year":"2002","journal-title":"Ann. Rheum. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1136\/ard.61.6.534","article-title":"Histological assessment of the early enthesitis lesion in spondyloarthropathy","volume":"61","author":"McGonagle","year":"2002","journal-title":"Ann. Rheum. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1136\/annrheumdis-2021-222061","article-title":"Concise report: A minimal-invasive method to retrieve and identify entheseal tissue from psoriatic arthritis patients","volume":"81","author":"Pachowsky","year":"2022","journal-title":"Ann. Rheum. Dis."},{"key":"ref_25","first-page":"373","article-title":"Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes","volume":"28","author":"Sconfienza","year":"2010","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"106978","DOI":"10.1016\/j.crad.2025.106978","article-title":"Evaluation of shear wave elastography and B-mod ultrasonography of the achilles tendons in psoriasis patients without clinical diagnosis of psoriatic arthritis","volume":"87","author":"Temel","year":"2025","journal-title":"Clin. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"R\u00f6mer, C., Zessin, E., Czupajllo, J., Fischer, T., Wolfarth, B., and Lerchbaumer, M.H. (2023). Effect of Anthropometric Parameters on Achilles Tendon Stiffness of Professional Athletes Measured by Shear Wave Elastography. J. Clin. Med., 12.","DOI":"10.3390\/jcm12082963"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1093\/rheumatology\/keac346","article-title":"Non-invasive metabolic profiling of inflammation in joints and entheses by multispectral optoacoustic tomography","volume":"62","author":"Tascilar","year":"2023","journal-title":"Rheumatology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.rdc.2016.07.012","article-title":"Imaging Evaluation of the Entheses","volume":"42","author":"Terslev","year":"2016","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1055\/s-0039-3401042","article-title":"High-Frequency and Ultra-High Frequency Ultrasound: Musculoskeletal Imaging up to 70 MHz","volume":"24","author":"Albano","year":"2020","journal-title":"Semin. Musculoskelet. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"335","DOI":"10.3899\/jrheum.121123","article-title":"No enthesis should be overlooked when psoriatic arthritis is suspected: Enthesitis of the extensor digitorum tendons","volume":"40","author":"Filippou","year":"2013","journal-title":"J. Rheumatol."},{"key":"ref_32","first-page":"459","article-title":"Differentiation between early rheumatoid and early psoriatic arthritis by the ultrasonographic study of the synovio-entheseal complex of the small joints of the hands","volume":"34","author":"Zabotti","year":"2016","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"28","DOI":"10.46497\/ArchRheumatol.2025.10780","article-title":"Mini-enthesitis can differentiate rheumatoid arthritis from psoriatic arthritis: A comprehensive comparative ultrasound study of the joints and mini-entheses of the hands","volume":"40","author":"Sapundzhieva","year":"2025","journal-title":"Arch. Rheumatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3050","DOI":"10.1093\/rheumatology\/kead614","article-title":"Characterization of digital annular pulleys and their entheses: An ultrasonographic study with anatomical and histological correlations","volume":"63","author":"Coronel","year":"2024","journal-title":"Rheumatology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1136\/ard-2023-225278","article-title":"Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis","volume":"83","author":"Naredo","year":"2024","journal-title":"Ann. Rheum. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e005544","DOI":"10.1136\/rmdopen-2025-005544","article-title":"Ultrasonographic study of the thumb pulleys and their entheses: Correlations with anatomy and histology","volume":"11","author":"Coronel","year":"2025","journal-title":"RMD Open"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e005783","DOI":"10.1136\/rmdopen-2025-005783","article-title":"High-frequency ultrasound can detect inflammatory changes of the finger pulleys anatomical entheses in early psoriatic arthritis","volume":"11","author":"Coronel","year":"2025","journal-title":"RMD Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1046\/j.1469-7580.1998.19340481.x","article-title":"Fibrocartilage in tendons and ligaments\u2014An adaptation to compressive load","volume":"193","author":"Benjamin","year":"1998","journal-title":"J. Anat."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"112459","DOI":"10.1016\/j.ejrad.2025.112459","article-title":"Metacarpophalangeal Joints of the Long Fingers: Anatomy, Biomechanics, and Imaging Techniques","volume":"194","author":"Bouredoucen","year":"2026","journal-title":"Eur. J. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e14431","DOI":"10.1097\/MD.0000000000014431","article-title":"Characteristics of late-onset spondyloarthritis in Japan: A retrospective cohort study","volume":"98","author":"Endo","year":"2019","journal-title":"Medicine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"152612","DOI":"10.1016\/j.semarthrit.2024.152612","article-title":"Value of ultrasound-assessed dactylitis in the early diagnosis of psoriatic arthritis","volume":"70","author":"Godo","year":"2025","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1111\/j.1469-7580.2008.00887.x","article-title":"An immunohistochemical study of the extracellular matrix of entheses associated with the human pisiform bone","volume":"212","author":"Adamczyk","year":"2008","journal-title":"J. Anat."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.ejrad.2009.12.019","article-title":"Enthesiopathy of the flexor carpi ulnaris at the pisiform: Findings of high-frequency sonography","volume":"77","author":"Wick","year":"2011","journal-title":"Eur. J. Radiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1159\/000182250","article-title":"The Nail as a Musculoskeletal Appendage\u2014Implications for an Improved Understanding of the Link between Psoriasis and Arthritis","volume":"218","author":"McGonagle","year":"2009","journal-title":"Dermatology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1093\/rheumatology\/kel214","article-title":"The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis\u2014A high-resolution MRI and histological study","volume":"46","author":"Tan","year":"2007","journal-title":"Rheumatology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1159\/000343607","article-title":"Ultrasonographic assessment of nail in psoriatic disease shows a link between onychopathy and distal interphalangeal joint extensor tendon enthesopathy","volume":"225","author":"Aydin","year":"2012","journal-title":"Dermatology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"5318","DOI":"10.5826\/dpc.1503a5318","article-title":"Clinical and Ultrasonographic Assessment of Nail Psoriasis: A Comprehensive Study","volume":"15","author":"Esposito","year":"2025","journal-title":"Dermatol. Pract. Concept."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1007\/s11547-022-01568-4","article-title":"Nail and enthesis assessment in patients with psoriatic disease by high frequency ultrasonography: Findings from a single-centre cross-sectional study","volume":"127","author":"Ruscitti","year":"2022","journal-title":"Radiol. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"688","DOI":"10.3899\/jrheum.170146","article-title":"Nail Enthesis Ultrasound in Psoriasis and Psoriatic Arthritis: A Report from the 2016 GRAPPA Annual Meeting","volume":"44","author":"Cunha","year":"2017","journal-title":"J. Rheumatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s42358-021-00207-2","article-title":"Ultrasonographic and resistance index evaluation of nails in psoriatic arthritis, psoriasis, and control groups: A cross-sectional study","volume":"61","author":"Palominos","year":"2021","journal-title":"Adv. Rheumatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1093\/rheumatology\/kes014","article-title":"Development of a preliminary US power Doppler composite score for monitoring treatment in PsA","volume":"51","author":"Gutierrez","year":"2012","journal-title":"Rheumatology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.semarthrit.2017.05.002","article-title":"Ultrasound entheseal abnormalities at the distal interphalangeal joints and clinical nail involvement in patients with psoriasis and psoriatic arthritis, supporting the nail-enthesitis theory","volume":"47","author":"Ruta","year":"2017","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"177","DOI":"10.11152\/mu-1327","article-title":"Ultrasonography of the nail unit reveals quantitative and qualitative alterations in patients with psoriasis and psoriatic arthritis","volume":"20","author":"Idolazzi","year":"2018","journal-title":"Med. Ultrason."},{"key":"ref_54","first-page":"8251097","article-title":"Ultrasound Assessment of Changes in Nails in Psoriasis and Psoriatic Arthritis","volume":"2018","author":"Placek","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1007\/s00296-018-4160-8","article-title":"Assessment of nail unit structures by ultrasound in patients with psoriatic arthritis and their correlations with disease activity indices: A case-control study","volume":"38","author":"Mondal","year":"2018","journal-title":"Rheumatol. Int."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"105197","DOI":"10.1016\/j.jbspin.2021.105197","article-title":"A standardized sonographic analysis of nails in psoriatic arthritis and healthy controls: Feasibility, reliability, diagnostic performance, and demographic and clinical associations","volume":"88","author":"Gezer","year":"2021","journal-title":"Jt. Bone Spine"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Krajewska-W\u0142odarczyk, M., \u017buber, Z., and Owczarczyk-Saczonek, A. (2021). Ultrasound Evaluation of the Effectiveness of the Use of Acitretin in the Treatment of Nail Psoriasis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10102122"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Krajewska-W\u0142odarczyk, M., Owczarczyk-Saczonek, A., Placek, W., Wojtkiewicz, M., and Wojtkiewicz, J. (2018). Effect of Methotrexate in the Treatment of Distal Interphalangeal Joint Extensor Tendon Enthesopathy in Patients with Nail Psoriasis. J. Clin. Med., 7.","DOI":"10.3390\/jcm7120546"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1111\/1346-8138.16074","article-title":"Apremilast improves quality of life and ultrasonography parameters in patients with nail psoriasis: A prospective cohort study","volume":"48","author":"Vidal","year":"2021","journal-title":"J. Dermatol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2045","DOI":"10.1007\/s00256-025-04901-w","article-title":"High-resolution ultrasound of the annular pulley system in the toes: Sonographic anatomy and pathological cases","volume":"54","author":"Pistoia","year":"2025","journal-title":"Skelet. Radiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1002\/acr.23180","article-title":"Ultrasound Features of the Posterior Tibialis Tendon and Peroneus Brevis Tendon Entheses: Comparison Study Between Healthy Adults and Those with Inflammatory Arthritis","volume":"69","author":"Ward","year":"2017","journal-title":"Arthritis Care Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"105649","DOI":"10.1016\/j.jbspin.2023.105649","article-title":"Ankle retinacula abnormalities as features of psoriatic arthritis: An ultrasound study","volume":"91","author":"Forien","year":"2024","journal-title":"Jt. Bone Spine"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1136\/annrheumdis-2018-213609","article-title":"Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: An OMERACT US initiative","volume":"77","author":"Balint","year":"2018","journal-title":"Ann. Rheum. Dis."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Seskute, G., Jasionyte, G., Rugiene, R., and Butrimiene, I. (2023). The Use of Superb Microvascular Imaging in Evaluating Rheumatic Diseases: A Systematic Review. Medicina, 59.","DOI":"10.3390\/medicina59091641"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1002\/jum.14369","article-title":"Diagnostic Performance of Superb Microvascular Imaging and Other Sonographic Modalities in the Assessment of Lateral Epicondylosis","volume":"37","author":"Arslan","year":"2018","journal-title":"J. Ultrasound Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1002\/acr.22195","article-title":"Value of contrast-enhanced ultrasonography for the detection and quantification of enthesitis vascularization in patients with spondyloarthritis","volume":"66","author":"Mouterde","year":"2014","journal-title":"Arthritis Care Res."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e003705","DOI":"10.1136\/rmdopen-2023-003705","article-title":"Intensive training programme for ultrasound-guided minimally invasive synovial tissue biopsy on knees and wrists in different phases of inflammation","volume":"10","author":"Coletto","year":"2024","journal-title":"RMD Open"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e005328","DOI":"10.1136\/rmdopen-2024-005328","article-title":"Minimally invasive ultrasound-guided biopsy of the common extensor tendon enthesis: A cadaveric study to standardise the technique","volume":"11","author":"Rizzo","year":"2025","journal-title":"RMD Open"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.ard.2025.08.032","article-title":"Entheseal tissue signature in response to IL-17A inhibition in psoriatic arthritis: Results from the EBIO entheseal biopsy study","volume":"85","author":"Raimondo","year":"2026","journal-title":"Ann. Rheum. Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s11547-023-01732-4","article-title":"Shear-wave elastography for the evaluation of tendinopathies: A systematic review and meta-analysis","volume":"129","author":"Albano","year":"2024","journal-title":"Radiol. Med."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Daskareh, M., Mehdipour Dalivand, M., Esmaeilian, S., Pourrajabi, A., Moshtaghioon, S.A., Rahmanipour, E., Jamshidi, A., Alikhani, M., and Ghorbani, M. (2025). Diagnostic Accuracy of Shear Wave Elastography Versus Ultrasound in Plantar Fasciitis Among Patients with and Without Ankylosing Spondylitis. Diagnostics, 15.","DOI":"10.3390\/diagnostics15151967"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/bjr\/tqae250","article-title":"Defining normal enthesis stiffness range in a healthy adult population","volume":"98","author":"Mahazer","year":"2025","journal-title":"Br. J. Radiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s00256-023-04425-1","article-title":"2D shear wave elastography for the assessment of quadriceps entheses-a methodological study","volume":"53","author":"Leong","year":"2024","journal-title":"Skelet. Radiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1002\/art.42917","article-title":"Unveiling Metabolic Similarities of Entheses in Patients with Psoriasis and Psoriatic Arthritis Using Noninvasive In Vivo Molecular Imaging: Results from a Cross-sectional Exploratory Study","volume":"76","author":"Fagni","year":"2024","journal-title":"Arthritis Rheumatol."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Russo, A., Reginelli, A., Lacasella, G.V., Grassi, E., Karaboue, M.A.A., Quarto, T., Busetto, G.M., Aliprandi, A., Grassi, R., and Berritto, D. (2022). Clinical Application of Ultra-High-Frequency Ultrasound. J. Pers. Med., 12.","DOI":"10.3390\/jpm12101733"},{"key":"ref_76","first-page":"32","article-title":"Microvascular evaluation in MSK ultrasound","volume":"12","author":"Fischetti","year":"2025","journal-title":"J. Med. Imaging Interv. Radiol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1002\/art.10812","article-title":"Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: A cross-sectional study","volume":"48","author":"Brasseur","year":"2003","journal-title":"Arthritis Rheum."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1136\/ard.2007.084251","article-title":"Validity of enthesis ultrasound assessment in spondyloarthropathy","volume":"68","author":"Cobo","year":"2009","journal-title":"Ann. Rheum. Dis."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1136\/ard.2006.062174","article-title":"A sonographic enthesitic index of lower limbs is a valuable tool in the assessment of ankylosing spondylitis","volume":"66","author":"Alcalde","year":"2007","journal-title":"Ann. Rheum. Dis."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"e006088","DOI":"10.1136\/rmdopen-2025-006088","article-title":"Topography of entheseal lesions on ultrasound: A comparative study between axial spondyloarthritis, psoriatic arthritis and healthy controls","volume":"11","author":"Elsehrawy","year":"2025","journal-title":"RMD Open"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"e640","DOI":"10.1016\/S2665-9913(23)00269-2","article-title":"Synovial tissue for personalised medicine in rheumatoid arthritis: Hype or hope?","volume":"5","year":"2023","journal-title":"Lancet Rheumatol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1038\/s41584-023-01016-1","article-title":"Imaging in inflammatory arthritis: Progress towards precision medicine","volume":"19","author":"Minopoulou","year":"2023","journal-title":"Nat. Rev. Rheumatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3753\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:01:20Z","timestamp":1779357680000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3753"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":82,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103753"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103753","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]}}}