Background/Purpose: Recent studies have developed criteria for US definition of entheseal abnormalities (1), however no actual scores are available to determine the extension and severity of enthesophyte growth at patient level.
To evaluate the feasibility of two new scores to measure enthesophytes occurrence and their dimensional changes with time.

Methods: We evaluated 816 enthesis in a consecutive series of 68 IBD patients for the presence and size of enthesophytes.  Images were collected at baseline and after 24 months using an Esaote MyLabClass, 18-6 MHz linear multi-frequency transducer both in B-mode and power Doppler-mode. The following sites were evaluated bilaterally: lateral epicondyle of the humerus, distal quadriceps femoris insertion into the patella, inferior pole of the patella, tibial distal insertion of the patellar tendon, calcaneal insertion of the Achilles tendon, and plantar aponeurosis insertion. The presence of enthesophyte was scored dichotomously as present (=1) or absent (=0) for each site and summed up to generate the ARES (Anatomical ReggioEmilia Enthesophytes Score). Enthesophytes were also scored semiquantitatively in a 0-3 scale (0 = absent, 1 = minimal, 2 = discrete, 3 = massive) according to previous studies (2) for each site and summed up to generate RESS (ReggioEmilia Enthesophytes Severity Score). All the stored images were reviewed and scored by 4 rheumatologists (FM, GC, PM, NG) well trained in US examination of enthesis. Four patients were evaluated independently by the 4 ultrasonographers and new ARES and RESS were calculated for each patient. Intraclass correlation coefficients (ICC) were calculated for inter- and intra-observer reliability.

Results: Both intra- and interobserver reliability analyses for presence or absence of enthesophytes showed an excellent ICC for each site. ICC for ARES was excellent for intra and inter observer (Cronbach alfa = 0.930, 95%CI 0.72-0.98 and 0.969, 95% CI 0.942-0.998 respectively). ICC was excellent also for the semiquantitative RESS for almost all the examined sites, but  moderate for the plantar fascia (Cronbach alfa = 0.571, 95%CI -0.72-0.89). The total RESS had an excellent ICC both for intra and inter-examiner (Cronbach alfa = 0.963, 95%CI 0.85-0.99 and 0.983, 95%CI 0.913-0.999).

Conclusion: The present study demonstrates that the ARES and RESS scores are easily feasible, highly reproducible and have excellent intra and interobserver reliability.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/definition-of-new-ultrasound-enthesophytes-score-application-in-a-consecutive-series-of-ibd-patients/