A Narrative Review of the Design of Ultrasound Indices for Detecting Enthesitis

With the increased utilization of musculoskeletal ultrasound in clinical practice, there has been rapid proliferation of publications on sonographic evaluation of enthesitis. This has led to the development of multiple new approaches to scoring sonographic findings in the detection of enthesitis, with variations including entheseal sites and sonographic features that limit cross-study comparisons. Furthermore, despite efforts to standardize the definition of enthesitis, there is still heterogeneity in the sonographic features included in existing ultrasound scores, and additional adjustments are required to distinguish active inflammatory changes from non-inflammatory conditions and to adjust for demographic features associated with increased prevalence of abnormal sonographic findings. This review provides an update on the current landscape of ultrasound scoring systems for enthesitis and emphasizes the importance of future data-based ultrasound scoring systems to improve the distinction between inflammatory and non-inflammatory or degenerative changes of the enthesis.