Clinical and sonographic enthesis assessment in primary fibromyalgia patients

Fibromyalgia (FM) is a chronic condition marked by widespread pain, fatigue and other functional symptoms. Musculoskeletal ultrasonography (US) is particularly valuable due to its accessibility and sensitivity in detecting enthesitis. Aim of this work is to evaluate the performance of sonographic examination using Madrid Sonography Enthesitis Index (MASEI) score in detection of enthesopathy in primary FM patients compared to clinical examination. The present study included 100 subjects (50 primary FM subjects and 50 healthy control subjects). Patients were clinically assessed for tender points (enthesitis). Fibromyalgia impact questionnaire (FIQ) was used for assessment of general health and pain in FM group. Ultrasonographic enthesitis assessment was done using MASEI score. Comparison of the sensitivity of both clinical entheseal tenderness & US detected enthesitis among the FM cases revealed high significance of US sensitivity compared to clinical examination in detection of enthesitis (p <0.001). Aimig at determining the optimal value for differentiation between normal and affected subjects based on US findings utilizing ROC curve, a cut-off value of MASEI score > 10 was obtained with AUC 0.998 (95% CI , 0.993 to 1.00, P < 0.001 , sensitivity 98% and specificity 90%). US detected significant entheseal changes among FM patients compared to control group. Ultrasonographic assessment using MASEI score in detection of subclinical enthesitis among the FM cases is a valuable objective clinical additive tool in patients diagnosed as having primary fibromyalgia.