Mander et al developed an enthesis index for evaluating patients with ankylosing spondylitis. This can be used to monitor the patient initially and over time. The authors are from the University of Newcastle upon Tyne.
Patient selection: ankylosing spondylitis
Sites:
(1) single site (1)
(2) group sites (5)
(3) bilateral sites (12 sites on left and 12 on right)
Single site:
(1) manubriosternal joint
Group sites:
(1) costochondral junctions
(2) nuchal crests (superior nuchal line along the insertion of the trapezius)
(3) spinous processes of the cervical spine
(4) spinous processes of the thoracic spine
(5) spinous processes of the lumbar spine
Bilateral sites:
(1) greater tuberosity of the head of the humerus
(2) lateral epicondyle of the humerus at the elbow
(3) medial epicondyle of the humerus at the elbow
(4) iliac crest
(5) anterior superior iliac spine
(6) posterior superior iliac spine
(7) ischial tuberosity
(8) greater trochanter of the femur
(9) lateral condyle of the femur
(10) medial condyle of the femur
(11) Achilles tendon insertion into the calcaneus
(12) plantar fascia insertion into the calcaneus
where:
• The textual description of the sites is a little ambiguous. The listing above seems the only way to achieve the maximum score of 90 that all sources refer to.
Pain and Tenderness at Each Site |
Points |
none |
0 |
mild tenderness |
1 |
moderate tenderness |
2 |
wince or withdraw (severe tenderness) |
3 |
The scoring for a group site was based on the maximum pain/tenderness reading for all sites in the group.
total score =
= SUM(points for all sites)
Interpretation:
• minimum score: 0
• maximum score: 90
• The higher the score the greater the enthesis.
Purpose: To evaluate a patient with ankylosing spondylitis using the Mander Enthesis Index (MEI).
Specialty: Immunology/Rheumatology
Objective: laboratory tests, criteria for diagnosis
ICD-10: M45, M08.1,