Table 4.

Overview of common scoring or grading systems of enthesitis with ultrasound examinations in patients with SpA.

System	Sites Assessed	Scoring/Grading	Pros	Cons	Reference
Glasgow Ultrasound Enthesitis Scoring System (GUESS)	Superior pole of the patella (quadriceps tendon enthesis), Inferior pole of the patella (proximal patellar ligament enthesis), Tibial tuberosity (distal patellar ligament enthesis), Superior pole of the calcaneus (Achilles tendon enthesis), and Inferior pole of the calcaneus (plantar aponeurosis enthesis)	Thickness, bursitis, erosion, and enthesophyte. Each item scores one point. Total possible score on both lower limbs is 36.	Λ Fast Λ Simple	Λ Omits entheses of the upper limbs Λ Does not evaluate vascularization	Balint et al., Ann Rheum Dis, 2002. 61(10): 905–910
Sonographic Entheseal Index (SEI)	Superior pole of the patella (Quadriceps tendon enthesis), Inferior pole of the patella (Proximal insertion of the patellar tendon), Anterior tibial tuberosity (Distal insertion of the patellar tendon), Superior pole of the calcaneous (Achilles tendon enthesis), and Plantar pole of the calcaneous (Plantar aponeurosis enthesis)	Signs of acute injury: Thickening of tendon/aponeurosis, Hypoechogenicity of tendon/aponeurosis, Peritendinous/periaponeurotic oedema, Bursitis. Signs of chronic lesion: Tendon tear, Loss of thickness, Tendon calcification, Bone erosion. Each variable is scored as 0 (absence) or 1 (presence) and the maximum SEI scoring is 76 points	Λ Fast Λ Simple	Λ Omits entheses of the upper limbs Λ Does not evaluate vascularization	Alcalde et al. Ann Rheum Dis, 2007. 66(8): 1015-19
Madrid sonography enthesitis index (MASEI)	Inferior pole of the calcaneus (plantar aponeurosis enthesis), Superior pole of the calcaneus (Achilles tendon enthesis), Tibial tuberosity (distal patellar ligament enthesis), Inferior pole of the patella (proximal patellar ligament enthesis), Superior pole of the patella (quadriceps tendon enthesis), and Olecranon tuberosity (triceps tendon enthesis)	Each item scores one point, except for calcification (0, 1, 2, or 3) and erosion and Doppler signal (0 or 3). The total possible score on both sides (12 entheses) is 136.	Λ Fast Λ Simple Λ Includes PDUS evaluation Λ Includes upper extremity enthesitis evaluation Λ Widely used	Λ 0–3 scoring system could contribute to greater inter- and intra-rater inconsistency	de Miguel et al., Ann Rheum Dis, 2009. 68(2): 169–174
D’Agostino Scoring System		Stage 1: Vascularization at the cortical junction without abnormal findings in B mode. Stage 2a: Vascularization associated with swelling and/or decreased echogenicity at the cortical junction in B mode. Stage 3a: Same as stage 2a, plus erosions of cortical bone and/or calcification of enthesis, and optional surrounding bursitis. Stage 2b: Abnormal findings in B mode as in stage 2a, but without vascularization. Stage 3b: Abnormal findings in B mode as in stage 3a, but without vascularization.	Λ Could be applied to any enthesis Λ Includes PDUS evaluation	Λ Lack of quantification Λ Vascularization could be scarce	D’Agostinon et al., Arthritis Rheum, 2003. 48(2): 523–533