Ultrasonographic evaluation of the presence of subclinical enthesitis in recurrent uveitis patients

Objectives: It is aimed to ultrasonographically detect the presence of enthesitis, which is an entity of spondyloarthropathy (SpA) group diseases that are not clinically evident in cases of recurrent uveitis, and to ultrasonographically evaluate the effect of the presence of uveitis on enthesis involvement in axial SpA (AxSpA) disease without known peripheral involvement. Materials and Methods: : In this study; 19 AxSpA patients with recurrent uveitis and 20 AxSpA patients without a history of uveitis, 20 recurrent uveitis patients and 20 healthy volunteers in the same age range, aged 18-45, who were followed in the Department of Rheumatology and Ophthalmology at KTU Faculty of Medicine, were included. Patients with a history of enthesitis and those with enthesitis that could be detected by examination at the time of inclusion were excluded from the study. C-Reactive Protein (CRP), The Ankylosing Spondylitis Disease Activity Score-CRP (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were used to detect disease activity. Madrid Sonography Enthesitis Index (MASEI) was used, and an ultrasound evaluation was performed with a cutoff value of 18. Between the groups, a comparison was made regarding sociodemographic characteristics, disease duration and activity, clinical, and laboratory data in terms of MASEI and MASEI subparameters. Result: The mean MASEI scores were 13.9, 8.1, 5.8, and 4.0 in AxSpA, AxSpA with recurrent uveitis, recurrent uveitis, and healthy controls, respectively. In the AxSpA group and the AxSpA group with recurrent uveitis, there were 8 and 3 patients, respectively, who were above the cut-off, while in the other two groups, no patients above the cut-off were detected. The AxSpA group was statistically significantly higher than the recurrent uveitis and healthy control groups in both score and being above the cut-off(p<0,001). In AxSpA patients, enthesitis scores for the distal patellar tendon and triceps tendon regions, along with the number of entheses showing erosion, doppler signal, increased thickness, and structural damage, were found to be statistically significantly higher(p<0,05). When all individuals and AxSpA patients were evaluated separately, both groups showed a positive correlation with age and body mass index with MASEI(p>0,05). In AxSpA patients, no correlation was found between MASEI and BASDAI or CRP(p>0,05), but a positive correlation was observed with ASDAS-CRP(p<0,05). No correlation was found between the number of calcifications and symptom duration or diagnosis delay(p>0,05), but a positive correlation was observed with age and body mass index(p<0,05). Conclusion: As a result, subclinical enthesitis was detected in AxSpA patients followed without peripheral involvement.. Distal patellar tendon and triceps tendon regions enthesitis scores are higher in AxSpA patients. Enthesis involvement is affected by age and body mass index. Keywords: Subclinical enthesitis, recurrent uveitis, ultrasonography, MASEI, Axial Spondyloarthropathy