Role of ultrasound in the diagnostic work-up of spondyloarthritis

Purpose of review: The technological progress of ultrasound has permitted an accurate visualization of inflammation and structural changes of superficial tissues. This review focusses on the advantages and current limitations of ultrasound for visualizing enthesitis in the context of spondyloarthritis (SpA). Recent findings: Several studies have described the ultrasound features of enthesitis in SpA, revealing the high frequency of clinically asymptomatic findings and the added value of ultrasound, coupled with power Doppler, for diagnosing SpA. Encouraging reports on high agreement between observers and the sensitivity to change the technique were recently published. However, a number of essential issues are still largely unexplored. A correct and consensual definition of enthesitis is still missing, and the published data are sometimes contradictory on the diagnostic capability of ultrasound because of the different definitions of enthesitis used. The quality of the Doppler equipment still plays a crucial role for visualizing inflammation, and the validity of the technique for prognostic purposes needs to be addressed. Summary: Power Doppler ultrasound is a very promising tool, but still needs validation. Future standardized studies will permit ultrasound to become a reference method for diagnosis and monitoring SpA peripheral enthesitis in clinical practice and research. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.