The development and validation of a new diagnostic sonographic enthesitis score for psoriatic arthritis: Diagnostic Ultrasound Enthesitis Tool ( DUET )

OBJECTIVE: The Diagnostic Ultrasound Enthesitis Tool (DUET) study aimed to develop and validate a new sonographic scoring system for enthesitis to aid PsA diagnosis. METHODS: We prospectively enrolled patients with early PsA, psoriasis without arthritis (PsO), and non-inflammatory musculoskeletal symptoms as controls (CTL) from 17 centers. A standardized ultrasound assessment of 16 entheseal sites was performed and images were centrally scored by three blinded readers for inflammatory and structural entheseal lesions. Using a stepwise approach with logistic regression models stratified by age, we identified optimal lesion combinations, weightings, and entheseal sites for distinguishing PsA from CTL. Age-specific cut-off points were selected to maintain specificity above 70%. Performance was assessed in a validation cohort of PsA and CTL. RESULTS: We included 213 PsA, 100 PsO, and 106 CTL in the discovery cohort. The final DUET score combined weighted inflammatory (hypoechogenicity + thickening + Doppler grade x 2) and structural (enthesophyte grade + erosion x 3) scores at three entheseal sites: Achilles, proximal patellar tendon insertion, and triceps. Age stratification (≤55 vs. >55 years) improved discriminative performance. In the discovery cohort, DUET achieved an AUC of 0.65, with specificity of 73-74% and sensitivity of 47-49%. In an external validation cohort (101 PsA, 69 CTL), specificity improved to 74-100% with similar sensitivity (49-52%). Sensitivity increased up to 63% in patients with tender entheses. CONCLUSION: DUET is a novel, externally validated sonographic enthesitis score that could support the diagnostic assessment of patients with early PsA, particularly in individuals with tender entheses.

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Journal
Arthritis & Rheumatology
Published
2026-10-28
DOI
https://doi.org/10.1002/art.70384
Primary Topic
Spondyloarthritis Studies and Treatments
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article
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article

The development and validation of a new diagnostic sonographic enthesitis score for psoriatic arthritis: Diagnostic Ultrasound Enthesitis Tool ( DUET )

Maria Simona Stoenoiu, Josefina Marín, Janeth Yinh, Adrien Nzeusseu et al.
4 links
Arthritis & Rheumatology
Spondyloarthritis Studies and Treatments
article

The development and validation of a new diagnostic sonographic enthesitis score for psoriatic arthritis: Diagnostic Ultrasound Enthesitis Tool ( DUET )

Maria Simona Stoenoiu, Josefina Marín, Janeth Yinh, Adrien Nzeusseu, Lihi Eder, Nikolas Malliotis, Basant Elnady, André Lucas Ribeiro, Ernesto Rodríguez, Ari Polachek, Minna J. Kohler, Catherine Bakewell, Ilaria Tinazzi, Richard J. Cook, Ágnes Szentpétery, Arnon M. Katz, Nam Nguyen, Gurjit Singh Kaeley, Marcos Gabriel Rosemffet, Philippe Carron, Dennis McGonagle, Arthur Kavanaugh, Mu Yang, Ricardo Acayaba de Toledo, Amir Haddad, Fahmeen Afgani, Abha Singh, Sibel Zehra Aydin
article en

Abstract

OBJECTIVE: The Diagnostic Ultrasound Enthesitis Tool (DUET) study aimed to develop and validate a new sonographic scoring system for enthesitis to aid PsA diagnosis. METHODS: We prospectively enrolled patients with early PsA, psoriasis without arthritis (PsO), and non-inflammatory musculoskeletal symptoms as controls (CTL) from 17 centers. A standardized ultrasound assessment of 16 entheseal sites was performed and images were centrally scored by three blinded readers for inflammatory and structural entheseal lesions. Using a stepwise approach with logistic regression models stratified by age, we identified optimal lesion combinations, weightings, and entheseal sites for distinguishing PsA from CTL. Age-specific cut-off points were selected to maintain specificity above 70%. Performance was assessed in a validation cohort of PsA and CTL. RESULTS: We included 213 PsA, 100 PsO, and 106 CTL in the discovery cohort. The final DUET score combined weighted inflammatory (hypoechogenicity + thickening + Doppler grade x 2) and structural (enthesophyte grade + erosion x 3) scores at three entheseal sites: Achilles, proximal patellar tendon insertion, and triceps. Age stratification (≤55 vs. >55 years) improved discriminative performance. In the discovery cohort, DUET achieved an AUC of 0.65, with specificity of 73-74% and sensitivity of 47-49%. In an external validation cohort (101 PsA, 69 CTL), specificity improved to 74-100% with similar sensitivity (49-52%). Sensitivity increased up to 63% in patients with tender entheses. CONCLUSION: DUET is a novel, externally validated sonographic enthesitis score that could support the diagnostic assessment of patients with early PsA, particularly in individuals with tender entheses.

Arthritis & Rheumatology
Intermountain Healthcare (US), University of North Florida (US), Uppsala University (SE), University of Leeds (GB), Cliniques Universitaires Saint-Luc (BE), Faculdade de Medicina de São José do Rio Preto (BR), Uppsala University Hospital (SE), University of Arizona (US), University of Waterloo (CA), University of Ottawa (CA), Tel Aviv University (IL), Technion – Israel Institute of Technology (IL), University of Toronto (CA), Benha University (EG), Tel Aviv Sourasky Medical Center (IL), Rabin Medical Center (IL), Ghent University Hospital (BE), Women's College Hospital (CA), Ghent University (BE), Jacksonville University (US), Hospital Moinhos de Vento (BR), Massachusetts General Hospital (US), Ospedale Sacro Cuore Don Calabria (IT), Banner - University Medical Center Phoenix (US), Instituto Nacional de Rehabilitación Psicofísica (AR), Armed Forces Hospital (SA), Carmel Medical Center (IL), VIB-UGent Center for Inflammation Research (BE), Hospital de Base (BR), Ottawa Hospital Research Institute (CA), University of Arizona College of Medicine- Phoenix (US), Florida College (US), UCLouvain (BE), KU Leuven (BE)
Eli Lilly and Company, Pfizer
Good health and well-being
Openalex Percentile: Top 11%
Spondyloarthritis Studies and Treatments
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