Article Text

Download PDFPDF

Original research
Atlas of the OMERACT Heel Enthesitis MRI Scoring System (HEMRIS)
  1. Ashish J Mathew1,2,3,
  2. Simon Krabbe1,2,
  3. Iris Eshed4,
  4. Robert GW Lambert5,6,
  5. Jean-Denis Laredo7,
  6. Walter P Maksymowych8,9,
  7. Frederique Gandjbakhch10,11,
  8. Yasser Emad12,
  9. Maria Simona Stoenoiu13,14,
  10. Violaine Foltz10,11,
  11. Paul Bird15,
  12. Philippe Carron16,
  13. Joel Paschke8,
  14. Philip G Conaghan17,18,
  15. Susanne J Pedersen1,
  16. Daniel Glinatsi1,19 and
  17. Mikkel Østergaard1,2
  1. 1Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark
  2. 2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  3. 3Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
  4. 4Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  5. 5Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
  6. 6Medical Imaging Consultants, Edmonton, Alberta, Canada
  7. 7Service de Radiologie, Hôpital Lariboisiére, APHP & Université Paris-Diderot, Paris, France
  8. 8CaRE (Canadian Research Education) Arthritis, Edmonton, Alberta, Canada
  9. 9Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  10. 10Department of Rheumatology, CHU Pitié-Salpêtrière, Assistance Publique—Hôpitaux de Paris, Paris, France
  11. 11Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
  12. 12Rheumatology, Faculty of Medicine, Cairo University, Giza, Egypt
  13. 13Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
  14. 14Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain La Faculte de Medecine, Brussels, Belgium
  15. 15Division of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  16. 16Rheumatology, Ghent University Hospital, Ghent, Belgium
  17. 17Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  18. 18Leeds Teaching Hospitals NHS Trust, NIHR Leeds Biomedical Research Centre, Leeds, UK
  19. 19Rheumatology, Skaraborg Hospital Skövde, Skovde, Sweden
  1. Correspondence to Dr Ashish J Mathew; ashishjacobmathew{at}


Objective Assessment of enthesitis, a key feature in spondyloarthritis (SpA) and psoriatic arthritis (PsA), using objective and sensitive methods is pivotal in clinical trials. MRI allows detection of both soft tissue and intra-osseous changes of enthesitis. This article presents an atlas for the Outcome Measures in Rheumatology (OMERACT) Heel Enthesitis Magnetic Resonance ImagingMRI Scoring System (HEMRIS).

Methods Following a preliminary selection of potential examples of each grade, as per HEMRIS definitions, the images along with detailed definitions and reader rules were discussed at web-based, interactive meetings between the members of the OMERACT MRI in Arthritis Working Group.

Results Reference images of each grade of the MRI features to be assessed using HEMRIS, along with reader rules and recommended MRI sequences are depicted.

Conclusion The presented reference images can be used to guide scoring Achilles tendon and plantar fascia (plantar aponeurosis) enthesitis according to the OMERACT HEMRIS in clinical trials and cohorts in which MRI enthesitis is used as an outcome.

  • spondyloarthritis
  • psoriatic arthritis
  • magnetic resonance imaging

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors All the authors contributed equally towards the work involved and manuscript preparation.

  • Funding PGC is supported in part by the UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All the images used are included in this atlas.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.