Table 2.

Overview of physical examination systems used to assess enthesitis in patients with SpA (Ref. McGonagle et al., Semin Arthritis Rheum., 2021 Jul 9; 51(6): 1147–1161).

Index	Site Assessed	Scoring	Pros	Cons	Reference
Mander Enthesitis Index/Newcastle index	66 in total: nuchal crests, manubriosternal joint, costochondral joints, greater tuberosity and medial and lateral epicondyles of the humerus, iliac crests, anterior superior iliac spines, greater trochanter of the femur, medial and lateral condyles of the femur, insertion of the Achilles tendons and plantar fascia to the calcaneus, cervical, thoracic, and lumbar spinous processes, ischial tuberosities, and posterior superior iliac spines	Each site rated from 0 to 3 (where 0 = no pain, 1 = mild tenderness, 2 = moderate tenderness, and 3 = wince or withdraw). Some of the sites are scored individually whereas others are scored as a group; max total score = 90	Λ Comprehensive Λ Captures wide range of axial and peripheral sites Λ Validated in ankylosing spondylitis	Λ Time consuming Λ Potential overlap with fibromyalgia tender points Λ 0–3 scoring system could contribute to greater inter- and intra-rater inconsistency	Mander et al., Ann Rheum Dis, 1987; 46: 197–202
Maastricht Ankylosing Spondylitis Enthesitis Score	13 in total: first costochondral joint, seventh costochondral joint, posterior superior iliac spine, anterior superior iliac spine, iliac crest, fifth lumbar spinous process, and proximal insertion of Achilles tendon	Presence or absence of tenderness; max score = 13	Λ Recommended by ASAS Λ Fast Λ Simple Λ Widely used in clinical trials	Λ Omits commonly affected yet accessible axial sites Λ Omits commonly affected peripheral sites, except the Achilles tendon	Heuft-Dorenbosch et al., Ann Rheum Dis, 2003; 62: 127–132
SPARCC Enthesitis Index	16 in total: the greater trochanter, quadriceps tendon insertion into the patella, patellar ligament insertion into the patella and tibial tuberosity, Achilles tendon insertion, plantar fascia insertion, medial and lateral epicondyles, and the supraspinatus insertion	Presence or absence of tenderness; max score = 16	Λ Fast Λ Simple Λ Widely used in clinical trials	Λ Includes peripheral sites only	Maksymowych et al., Ann Rheum Dis, 2009; 68: 948–53
Leeds Enthesitis Index	6 in total: bilateral lateral epicondyles, medial femoral condyles, and Achilles tendon insertions	Presence or absence of tenderness; max score = 6	Λ Fast Λ Simple Λ Widely used in clinical trials	Λ Includes peripheral sites only	Healy and Helliwell, Arthritis Rheum, 2008; 59: 686–691
Gladman Index	6 in total: bilateral tibial tuberosity, plantar fascia and Achilles tendon insertion)	Presence or absence of tenderness; max score = 6	Λ Fast Λ Simple	Λ Seldom used Λ Omits commonly affected yet accessible axial sites	Healy and Helliwell, Arthritis Rheum, 2008; 59: 686–691
Berlin/Major Index	12 in total: iliac crest, proximal Achilles, greater trochanter, medial condyle femur, lateral condyle femur, and insertion plantar fascia	Presence or absence of tenderness; max score = 12	Λ Fast Λ Simple	Λ Seldom used Λ Omits commonly affected yet accessible axial sites	Polachek et al. Arthritis Care Res, 2017; 69: 1685–1691
University of California San Francisco Enthesitis Index	17 in total: vertebral processes of Cl-C2, C7-T1, T12-L1, L5-S1, symphysis pubis, both greater trochanters, pelvic abductor origin, anterior superior border of the iliac crests, ischial tuberosities, insertions of Achilles tendons, and plantar fascia	Each site rated from 0 to 3 (where 0 = no pain, 1 = mild tenderness, 2 = moderate tenderness, and 3 = wince or withdraw). Some of the sites are scored individually whereas others are scored as a group; max total score = 51	Λ Includes spinous processes	Λ Seldom used Λ 0–3 scoring system could contribute to greater inter- and intra-rater inconsistency Λ Omits key peripheral sites	Clegg et al., Arthritis Rheum, 1996; 39: 2004–2012