{
  "abstract": "Background and Aims Spondyloarthropathies (SpA) often present with peripheral musculoskeletal symptoms that precede radiographic findings by several years. Enthesitis is a hallmark of SpA, yet its diagnosis can be delayed due to non-specific symptoms. Musculoskeletal ultrasonography (US) is a sensitive and non-invasive tool for detecting early inflammatory changes at entheses. This report illustrates a case of early peripheral SpA presenting with posterior elbow pain, in which US identified triceps enthesitis prior to definitive diagnosis, enabling timely rheumatologic referral and targeted intervention.Methods A 26-year-old male with a history of Graves’ disease and relapsing pain for two years at multiple joints presented to a pain clinic with acute-onset posterior elbow pain lasting five days, exacerbated in the morning and during resisted extension. Tenderness was noted at the triceps insertion and olecranon fat pad without visible swelling. There was no history of trauma. Musculoskeletal US was performed using a high-frequency linear probe to evaluate for enthesitis.Results US demonstrated grade 2 hyperemia at the triceps enthesis and adjacent fat pad, suggestive of active inflammation ( figure 1). The patient was referred to a rheumatologist. He was diagnosed with peripheral SpA according to the Assessment of Spondyloarthritis International Society (ASAS) criteria. Treatment with acemetacin and hydroxychloroquine was initiated, along with physical therapy focused on postural correction and triceps strengthening. Follow-up US at one month showed complete resolution of Doppler signal and normalization of tendon structure. No recurrence was noted at six months.Abstract P192 Figure 1(A) Grade 2 hyperemia of the triceps myotendinous junction and olecranon fat pad was appreciated in long-axis and (B) short-axis view on the symptomatic elbow. No hyperemia was noted on the (C) long- or (D) short-axis view on the asymptomatic sideConclusions This case highlights triceps enthesitis as a potential early manifestation of peripheral SpA and underscores the value of musculoskeletal US in detecting inflammation when conventional imaging remains inconclusive. US-guided evaluation of entheses—especially in atypical sites such as the triceps tendon—can facilitate earlier diagnosis and timely management. Incorporating ultrasound into the initial workup for patients with unexplained localized pain and inflammatory features may improve outcomes in early SpA.",
  "authors": [
    {
      "affiliations": [
        "Department of Physical Medicine and Rehabilitation, Cathay General Hospital, Taipei, Taiwan"
      ],
      "name": "Yi-Hong Wu"
    }
  ],
  "title": "P192 Triceps enthesitis as a clue to early spondyloarthropathy",
  "uid": "02a9726e-9431-5358-979d-78102ffb2544"
}