Assessment of Lower Limb Enthesitis in Rheumatoid Arthritis versus Spondyloarthropathies

New investigations have appeared for the diagnosis and prognostic prediction of rheumatoid arthritis and other rheumatic diseases. Among them musculoskeletal ultrasound seems to be attracting the most attention. As the ability of ultrasound to detect enthesitis in spondyloarthropathy become a reliable and useful tool in diagnosis so, we sought to assess other rheumatic diseases such as rheumatoid arthritis and we use power doppler ultrasound which is a sensitive tool to detect hyperemia to assess degree of activity of enthesitis. , we conducted our study with the aim (1) to detect the frequency of enthesitis in rheumatoid arthritis, (2) to evaluate the rule of ultrasound in detection of early subclinical abnormalities in asymptomatic rheumatoid arthritis patients and spondyloarthropathies and (3) to evaluate the degree of activity of rheumatoid arthritis and spondyloarthropathies diseases using power duplex in relation to laboratory and clinical assessment. Our results showed that enthesopathy in rheumatoid arthritis is founded by ultrasound more frequent than had been estimated when compared with control group but less frequent than in spondyloarthropathy patients. And we found that large number of entheseal abnormality in both reumatoid arthritis and spondyloarthropathy groups is not detected by clinical examination with higher advantage of ultrasound examination over clinical examination in detection of subclinical enthesopthy in asymptomatic cases of studied groups . Also In reumatoid arthritis group ,there was a significant correlation between clinical parameters such as tenderness (total pain score) and disease activity score 28 (DAS28), laboratory investigations ( ESR ,CRP) and power doppler flow signals (total power doppler score) while in seronegative spondyloarthropathies group , there was a significant correlation between clinical parameters such as tenderness (t-PS) , laboratory investigations ( ESR , CRP ) and power doppler US (total power doppler score).