Bayram FARİSOĞULLARI, Gamze ALAYLI, Ömer KURU
Journal of Experimental and Clinical Medicine - 2026;43(2):176-182
To evaluate clinical and ultrasonographic achilles tendon involvement in patients with spondyloarthritis (SpA) and to investigate its associations with ankle range of motion, isokinetic muscle strength, and foot- and ankle-related quality of life.Sixty patients with spondyloarthritis fulfilling ASAS classification criteria and 50 age- and sex-matched healthy controls were included. Clinical enthesopathy was assessed by physical examination. Disease activity, function, and enthesitis severity were evaluated using BASDAI, BASFI, and SPARCC indices. Achilles tendon ultrasound was performed and scored using the Glasgow Ultrasound Enthesitis Scoring System (GUESS). Ankle dorsiflexion and plantarflexion range of motion and isokinetic peak torque at 30 derece/s and 120 derece/s were measured. Foot and ankle-related outcomes were assessed using the Foot and Ankle Outcome Score (FAOS). Heel pain was more frequent in patients with SpA compared with controls (35% vs 2%, p<0.001). Mean Achilles tendon thickness was significantly higher in SpA (4.21+/-0.58 mm vs 3.93+/-0.42 mm, p=0.01), and GUESS scores were also higher (0.76+/-1.29 vs 0.26+/-0.59, p=0.04). Ankle dorsiflexion (15.08+/-7.58 vs 18.32+/-4.31 derece) and plantarflexion (41.91+/-7.15 vs 45.62+/-5.19 derece) were significantly reduced in SpA. All FAOS subscales were significantly lower (all p<0.001). FAOS scores showed moderate to strong correlations with pain and disease activity (r=-0.41 to -0.70, p<0.05). Achilles tendon involvement in SpA is associated with reduced ankle mobility and significant impairment in foot-ankle-related function and quality of life, even in the absence of marked reductions in isokinetic muscle strength. Comprehensive assessment of Achilles enthesitis may improve functional management in SpA.
