ORIGINAL ARTICLE Ultrasound revealing subclinical enthesopathy at the greater trochanter level in patients with spondyloarthritis Marwin Gutierrez & Filippo Luccioli & Fausto Salaffi & Elena Bartoloni & Chiara Bertolazzi & Vittorio Bini & Emilio Filipucci & Walter Grassi & Roberto Gerli Received: 11 July 2011 /Revised: 31 August 2011 /Accepted: 10 October 2011 /Published online: 21 October 2011 # Clinical Rheumatology 2011 Abstract This study was conducted to determine the prevalence of subclinical entheseal involvement at the greater trochanter level by ultrasound in patients with spondyloarthritis. Forty-six patients with spondyloarthritis and 46 healthy age- and sex-matched controls were studied. All patients with no clinical evidence of enthesopathy at the greater trochanter underwent an ultrasound examination. The following three entheses were scanned bilaterally: anterior insertion of gluteus minimus, anterior insertion of gluteus medius, and posterior insertion of gluteus medius. Ultrasound findings of enthesopathy were thickening, calcifications, bone erosions, enthesophytes, bursitis, and power Doppler signal. A total of 276 entheses were evaluated in spondyloarthritis patients. In 112 out of 276 (40.5%), grayscale ultrasound found enthesopathy. The enthesis with the highest number of signs of enthesopathy was the anterior insertion of gluteus medius (46/276) (16%), followed by posterior insertion of gluteus medius (37/276) (13.4%) and anterior insertion of gluteus minimus (29/276) (10.5%). In the healthy population, ultrasound found entesopathy in 80 out of 276 (29%) entheseal sites (p <0.0001). Posterior insertion of gluteus medius enthesis was the more frequently involved (34/276) (12.3%), followed by anterior insertion of gluteus medius (24/276) (8.6%) and anterior insertion of gluteus minimus (22/276) (7.9%). Power Doppler was found more frequently in patients with spondyloarthritis compared with healthy controls (1% vs 0%). Our results show a higher prevalence of subclinical enthesopathy at the greater trochanter level in patients with spondyloarthritis than in age- and sex- matched healthy controls. Keywords Enthesopathy . Greater trochanter . Spondyloarthritis . Subclinical Introduction Entheseal involvement is one of the most important features in patients with spondyloarthritis (SpA) [1–3]. It could represent the primary lesion preceding the other musculo- skeletal manifestations in SpA patients [4–6]. In daily rheumatologic practice, clinical examination is used to detect entheseal inflammatory signs, and composite indices have been proposed to assess and score these abnormalities, especially those located at the lower limb level [7, 8]. However, entheseal involvement may be asymptomatic and underestimated by clinical examination. Conventional radiography can demonstrate established bony erosions and spurs, but it gives little information about soft tissues, especially in the early phase of the disease [9–12]. Magnetic resonance imaging has the ability Marwin Gutierrez and Filippo Luccioli collaborated equally in this study. M. Gutierrez (*) : F. Salaffi : C. Bertolazzi : E. Filipucci : W. Grassi Clinica Reumatologica, Università Politecnica delle Marche, Ospedale “A. Murri”, Via dei Colli, 52, 60035 Iesi, Ancona, Italy e-mail: dr.gmarwin@gmail.com F. Luccioli : E. Bartoloni : R. Gerli Struttura di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Perugia, Perugia, Italy V. Bini Sezione di Medicina e Scienze Endocrine e Metaboliche, Università di Perugia, Perugia, Italy Clin Rheumatol (2012) 31:463–468 DOI 10.1007/s10067-011-1875-2