• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annrheumdAnnals of the Rheumatic DiseasesCurrent TOCInstructions for authors
Ann Rheum Dis. Feb 2003; 62(2): 127–132.
PMCID: PMC1754445

Assessment of enthesitis in ankylosing spondylitis


Objective: To assess, firstly, the validity of the enthesis index published by Mander (Mander enthesis index (MEI)) and, secondly, to investigate whether it is possible to define a new enthesis index that is less time consuming to perform with at least similar or better properties.

Methods: Data from the OASIS cohort, an international, longitudinal, observational study on outcome in ankylosing spondylitis, were used. In this study, measures of disease activity, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the MEI, were assessed regularly in 217 patients. With the MEI, for each measurement period independently, a process of data reduction was performed to identify the entheses most commonly reported as painful by the patients. A more concise enthesis index was constructed with aid of the entheses found in this way. Correlations with measures of disease activity were used to test the validity of several entheses indices.

Results: Reduction of the number of entheses from 66 to 13 and omitting grading of the intensity of pain resulted in an index which was named the "Maastricht Ankylosing Spondylitis Enthesitis Score" (MASES). The MASES (range 0–13) has much greater feasibility than the MEI (range 0–90). However, up to 21% of patients with a score >0 on the MEI were not identified by a score on the MASES >0. Only 2.1% of the patients with an original enthesis score >0 had an original score on the MEI >3 (range 0–90) and it can be questioned whether a low score on the MEI index represents clinically important enthesitis. The Spearman correlation coefficient between the MASES score and the MEI was 0.90 and between the MASES and the BASDAI was 0.53 compared with a correlation of 0.59 between the MEI and the BASDAI.

Conclusions: MASES seems to be a good alternative to the MEI with much better feasibility.

Full Text

The Full Text of this article is available as a PDF (155K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • van der Heijde D, Bellamy N, Calin A, Dougados M, Khan MA, van der Linden S. Preliminary core sets for endpoints in ankylosing spondylitis. Assessments in Ankylosing Spondylitis Working Group. J Rheumatol. 1997 Nov;24(11):2225–2229. [PubMed]
  • van der Heijde D, van der Linden S, Bellamy N, Calin A, Dougados M, Khan MA. Which domains should be included in a core set for endpoints in ankylosing spondylitis? Introduction to the ankylosing spondylitis module of OMERACT IV. J Rheumatol. 1999 Apr;26(4):945–947. [PubMed]
  • Mander M, Simpson JM, McLellan A, Walker D, Goodacre JA, Dick WC. Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis. Ann Rheum Dis. 1987 Mar;46(3):197–202. [PMC free article] [PubMed]
  • Boers M, Brooks P, Strand CV, Tugwell P. The OMERACT filter for Outcome Measures in Rheumatology. J Rheumatol. 1998 Feb;25(2):198–199. [PubMed]
  • Spoorenberg A, van der Heijde D, de Klerk E, Dougados M, de Vlam K, Mielants H, van der Tempel H, van der Linden S. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol. 1999 Apr;26(4):980–984. [PubMed]
  • Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994 Dec;21(12):2286–2291. [PubMed]
  • Jones SD, Calin A, Steiner A. An update on the Bath Ankylosing Spondylitis Disease Activity and Functional Indices (BASDAI, BASFI): excellent Cronbach's alpha scores. J Rheumatol. 1996 Feb;23(2):407–407. [PubMed]
  • Calin A, Nakache JP, Gueguen A, Zeidler H, Mielants H, Dougados M. Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument? Rheumatology (Oxford) 1999 Sep;38(9):878–882. [PubMed]
  • Ball J. Enthesopathy of rheumatoid and ankylosing spondylitis. Ann Rheum Dis. 1971 May;30(3):213–223. [PMC free article] [PubMed]
  • Gerster JC. Plantar fasciitis and Achilles tendinitis among 150 cases of seronegative spondarthritis. Rheumatol Rehabil. 1980 Nov;19(4):218–222. [PubMed]
  • Braun J, Brandt J, Listing J, Zink A, Alten R, Golder W, Gromnica-Ihle E, Kellner H, Krause A, Schneider M, et al. Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet. 2002 Apr 6;359(9313):1187–1193. [PubMed]
  • Marzo-Ortega H, McGonagle D, O'Connor P, Emery P. Efficacy of etanercept in the treatment of the entheseal pathology in resistant spondylarthropathy: a clinical and magnetic resonance imaging study. Arthritis Rheum. 2001 Sep;44(9):2112–2117. [PubMed]
  • Lehtinen A, Taavitsainen M, Leirisalo-Repo M. Sonographic analysis of enthesopathy in the lower extremities of patients with spondylarthropathy. Clin Exp Rheumatol. 1994 Mar-Apr;12(2):143–148. [PubMed]
  • Prevoo ML, van Riel PL, van 't Hof MA, van Rijswijk MH, van Leeuwen MA, Kuper HH, van de Putte LB. Validity and reliability of joint indices. A longitudinal study in patients with recent onset rheumatoid arthritis. Br J Rheumatol. 1993 Jul;32(7):589–594. [PubMed]
  • Dougados M, Gueguen A, Nakache JP, Velicitat P, Veys EM, Zeidler H, Calin A. Ankylosing spondylitis: what is the optimum duration of a clinical study? A one year versus a 6 weeks non-steroidal anti-inflammatory drug trial. Rheumatology (Oxford) 1999 Mar;38(3):235–244. [PubMed]
  • Dougados M, Béhier JM, Jolchine I, Calin A, van der Heijde D, Olivieri I, Zeidler H, Herman H. Efficacy of celecoxib, a cyclooxygenase 2-specific inhibitor, in the treatment of ankylosing spondylitis: a six-week controlled study with comparison against placebo and against a conventional nonsteroidal antiinflammatory drug. Arthritis Rheum. 2001 Jan;44(1):180–185. [PubMed]
  • McGonagle D, Gibbon W, Emery P. Classification of inflammatory arthritis by enthesitis. Lancet. 1998 Oct 3;352(9134):1137–1140. [PubMed]
  • McGonagle D, Khan MA, Marzo-Ortega H, O'Connor P, Gibbon W, Emery P. Enthesitis in spondyloarthropathy. Curr Opin Rheumatol. 1999 Jul;11(4):244–250. [PubMed]

Figures and Tables

An external file that holds a picture, illustration, etc.
Object name is ar0297.f1.jpg
Mander enthesis index. Reproduced with permission of the authors and the copyright holders from reference 3. Copyright @ 1987 Annals of the Rheumatic Disease.
Figure 2

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...