As you say, enthesitis a common cause of pain in PsA, but Fibromyalgia is present in up to 20% of patients with PsA, better clinical exam does help, simple palpation at points of tenderness is not advisable, pain on resistance at entheseal insertions more sensitive. Elbow, wrist, hand, knee and ankles are easily accessible. New US machines with high frequency probes 18-24MhZ are proving more useful in defining tendon morphology and improved Doppler such as SMI may also help. Big problems remain assessing tendons in patients who are older, have a history of physical work and repetitive injuries and assessing tendons in the feet and ankle in patients with high BMI. GRAPPA are working on it and we await results from their studies. The enthesitis indices must be revised to a more useful clinical set - studies are needed to see which sites will reveal the best clinical outcome and be measurable in clinical studies. Current studies mention the enthesitis indices often as a secondary outcome measure and this is unfortunately the best measure we have at the moment but far from ideal.
As you say, enthesitis a common cause of pain in PsA, but Fibromyalgia is present in up to 20% of patients with PsA, better clinical exam does help, simple palpation at points of tenderness is not advisable, pain on resistance at entheseal insertions more sensitive. Elbow, wrist, hand, knee and ankles are easily accessible. New US machines with high frequency probes 18-24MhZ are proving more useful in defining tendon morphology and improved Doppler such as SMI may also help. Big problems remain assessing tendons in patients who are older, have a history of physical work and repetitive injuries and assessing tendons in the feet and ankle in patients with high BMI. GRAPPA are working on it and we await results from their studies. The enthesitis indices must be revised to a more useful clinical set - studies are needed to see which sites will reveal the best clinical outcome and be measurable in clinical studies. Current studies mention the enthesitis indices often as a secondary outcome measure and this is unfortunately the best measure we have at the moment but far from ideal.