The Leeds Enthesitis Index (LEI) is a medical assessment tool used to evaluate enthesitis, a type of inflammation. It provides a standardized method for healthcare professionals to assess the presence and activity of this condition, particularly in individuals with inflammatory diseases, by focusing on key anatomical sites.
What is Enthesitis?
Enthesitis refers to inflammation at an enthesis, the specialized anatomical site where tendons, ligaments, or joint capsules attach to bone. These attachment points are numerous throughout the body and are designed to withstand significant mechanical stress during movement. When inflamed, an enthesis can lead to noticeable pain and stiffness.
This inflammation can manifest in various locations, including the heels (Achilles tendon), soles of the feet (plantar fascia), elbows, knees, hips, and along the spine. Symptoms involve localized pain that often worsens with movement or pressure, and sometimes swelling or redness. While overuse injuries can cause localized enthesitis, chronic forms are frequently associated with inflammatory conditions.
Measuring Enthesitis with the Index
The LEI measures enthesitis activity and severity. This assessment involves a clinical examiner palpating, or pressing on, six specific entheseal sites on the body: the Achilles tendon insertions at both heels, the lateral epicondyles of both humeri (elbows), and the medial condyles of both femurs (knees).
During the examination, the healthcare professional applies pressure to each of these six sites. The patient reports whether tenderness is present at each site. The LEI uses a simple scoring system where each tender site receives a score, leading to a total score that indicates the extent of enthesitis. This objective method allows for a standardized evaluation of entheseal pain.
Significance of the Index
The Leeds Enthesitis Index plays a role in evaluating and managing inflammatory conditions, particularly spondyloarthritis like psoriatic arthritis (PsA). Enthesitis is a characteristic feature of these diseases, and its presence can indicate greater disease activity.
By providing a quantifiable measure, the LEI supports healthcare professionals in making informed decisions about patient care, including adjusting treatment plans. The index is also used in clinical trials to evaluate new medications for conditions like psoriatic arthritis, helping determine if a treatment reduces enthesitis. Objectively measuring this inflammation aids in understanding the disease’s impact and response to therapy.