The Burden of Enthesitis, Inflammatory Arthritis, and Tenosynovitis on Musculoskeletal Ultrasound in Systemic Lupus Erythematosus: A Scoping Review.

Abstract

The objective of this scoping review was to summarize the current literature on the burden of inflammatory arthritis (IA), tenosynovitis, and enthesitis detected on musculoskeletal ultrasound (MSUS) in adult patients with systemic lupus erythematosus (SLE). A systematic literature search was performed using PubMed, Embase, and the Cochrane Library between January 1, 2015, and February 1, 2025, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. To be included, studies on the adult SLE population must have reported on either synovitis, tenosynovitis, or enthesitis. Exclusion criteria were pediatric studies, rhupus-only studies, case series with < 5 patients, review articles, and conference abstracts. A preestablished standardized data collection sheet was used. The literature search found 24 articles that met inclusion criteria. Studies reported on IA (n = 20), tenosynovitis (n = 16), and enthesitis (n = 7). Most studies were cross-sectional (n = 20/24). Using criteria that were discriminatory for inflammatory enthesitis (power Doppler and bone erosion), inflammatory enthesitis was found in patients with SLE and was more common at the distal patellar, proximal patellar, and quadriceps enthesis. In the general SLE population, studies on IA and tenosynovitis found clinical arthritis in 18-38% of patients, MSUS synovitis in 33-57% of patients, subclinical MSUS arthritis in 9-21% of patients, and tenosynovitis in 8-38% of patients. MSUS findings correlated with SLE disease activity indices, such as SLE Disease Activity Index (SLEDAI) and British Isles Lupus Assessment Group (BILAG). Enthesitis may be a new musculoskeletal domain in SLE. MSUS can be useful in diagnosing tenosynovitis and subclinical IA in patients with SLE.