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Enthesitis Imaging — SCE Rheumatology MCQ

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HardSpondyloarthropathyEnthesitis ImagingSCE Rheumatology

A 45-year-old woman with PsA has predominantly entheseal disease. She has Achilles enthesitis and plantar fasciitis bilaterally refractory to NSAIDs. Which imaging modality is most sensitive for detecting enthesitis?

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Correct answer: B — Ultrasound with Doppler for active peripheral enthesitis

The best answer is “Ultrasound with Doppler for active peripheral enthesitis”. Ultrasound with power Doppler is the most sensitive and accessible imaging modality for detecting enthesitis showing tendon thickening loss of normal fibrillar pattern enthesophyte formation cortical irregularity bursitis and power Doppler signal indicating active inflammation. It is more sensitive than clinical examination for detecting subclinical enthesitis. MRI also detects enthesitis but is less accessible and more expensive. X-ray only shows chronic entheseal changes (erosions and new bone formation) and misses early active inflammation. The competing options represent related diagnoses, tests or treatments, but they do not match the decisive phenotype, safety constraint or management point in this stem.

Reference: EULAR imaging recommendations for spondyloarthritis: https://ard.bmj.com/content/74/7/1327