OBJECTIVES: To explore the prevalence and distribution of ultrasound-detected lesions indicating structural damage at the enthesis (e.g., bone erosions, enthesophytes, and calcifications) in patients with spondyloarthritis (SpA), comparing those with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), and to investigate the demographic, clinical, and metabolic factors linked to these lesions. METHODS: A cross-sectional analysis was conducted using data from the DEUS study, a multicentre investigation involving 20 rheumatology centres and including 413 patients with SpA (224 with axSpA and 189 with PsA). All participants underwent standardized clinical and ultrasound assessment of the large lower limb entheses (quadriceps tendon, proximal and distal patellar tendons, Achilles tendon, and plantar fascia). Entheseal structural lesions were explored by ultrasound and classified according to OMERACT definitions. Bivariate analyses and multivariate logistic regression were used to assess associations between ultrasound lesions and SpA patients' characteristics. RESULTS: In SpA patients, enthesophytes were the most common lesion (78.7 %), followed by calcifications (43.6 %) and bone erosions (24.9 %). Enthesophytes were more prevalent in PsA (86.8 %) compared to axSpA (71.9 %) (p < 0.001), with no significant differences in erosions and calcifications. However, lesion distribution varied across different entheses. Multivariate analysis revealed that entheseal erosions were significantly associated with inflammatory markers, HLA-B27 positivity, clinical enthesitis, and longer disease duration. Enthesophytes were significantly linked to PsA, psoriasis, clinical enthesitis, and longer disease duration. Calcifications were positively associated with hypertension, metabolic syndrome, and obesity. All lesions were associated with biologic DMARD use. CONCLUSIONS: This study reveals a high prevalence of ultrasound-detected structural damage at the enthesis and identifies distinct SpA phenotypes based on these findings.

Centro Hospitalar e Universitário de Coimbra Medicine Faculty University of Coimbra

Department of Health Promotion Mother and Child Care Internal Medicine and Medical Specialties Rheumatology Section University of Palermo Palermo Italy

Department of Medicine Internal Medicine and Rheumatology Unit Azienda Ospedaliero Universitaria di Parma Parma Italy

Department of Paediatric and Adult Rheumatology University Hospital Motol Prague Czech Republic

Department of Precision and Rigenerative Medicine and Ionian Area Rheumatology Unit University of Bari Bari Italy

Department of Rheumatology and Immunology Guangdong Provincial People's Hospital Southern Medical University Guangdong China

Department of Rheumatology Hokkaido Medical Center for Rheumatic Diseases Sapporo Japan

Department of Rheumatology School of Health Sciences Faculty of Medicine University of Ioannina Ioannina Greece

Division of Rheumatology Department of Internal Medicine Faculty of Medicine Hacettepe University Ankara Turkey

General Hospital of Playa del Carmen Q Roo Mexico

Institucion Prestadora de Salud Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota

Institute of Psychophysical Rehabilitation Buenos Aires Argentina

Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds Leeds UK

Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds Leeds UK; Rheumatology Unit Department of Clinical and Molecular Sciences Carlo Urbani Hospital Polytechnic University of Marche Ancona Italy

Rheumatology Department Centro Hospitalar de Leiria Leiria Portugal; Faculty of Health Sciences University of Beira Interior Covilhã Portugal

Rheumatology Department Hospital Juárez de México Mexico City Mexico

Rheumatology Department Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca Romania

Rheumatology Hospital San Roque de Gonnet La Plata Argentina

Rheumatology Unit Department of Clinical and Molecular Sciences Carlo Urbani Hospital Polytechnic University of Marche Ancona Italy

Rheumatology Unit Department of Internal Medicine Hospital Italiano de Buenos Aires Buenos Aires Argentina

Rheumatology Unit IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy

Rheumatology Unit University Clinic AOU Cagliari Monserrato CA Italy

Rheumatology Unit Vall d'Hebron Hospital Universitari Vall d'Hebron Barcelona Hospital Campus Barcelona Spain

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