الفهرس 
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Abstract
Based on the above-mentioned findings, our study concluded that;
Shoulder pain is a frequent complaint in daily rheumatological practice. Several pathological conditions may account for it and their identification is essential for starting appropriate treatment.
Due to the complex anatomy of the shoulder, it is often difficult to identify and assess the alterations from the physical examination. MSUS is considered an increasingly reliable method for the evaluation of shoulder changes with high sensitivity and specificity.
US abnormalities of the shoulders are common in RA and AS patients.
RA patients had higher frequency of SASD bursitis, subscapular subcoracoid bursitis, LHBT tenosynovitis with PD signal, glenohumeral effusion, rotator cuff tendinopathy and humeral bone erosion compared to AS patients.
Rotator cuff enthesitis was the more specific MSUS features to be associated with diagnosis of AS with bilateral aspect of affection. Moreover, AC synovitis was more prevalent in AS shoulders compared to RA shoulders.
Our study showed that the site of inflammatory exudate varies considerably between individual RA and AS patients with shoulder pain. Thus, the use of MSUS and PD is strongly recommended to confirm the origin of inflammatory and noninflammatory shoulders and to determine the degree of inflammation in shoulder involvement.
In both RA and AS patients, presence of inflammatory al¬terations at the shoulders had higher disease activity, as shown by higher levels of ESR, CRP, VAS (by patient and by physician), VAS of shoulder pain by the patient and VAS of shoulder tenderness & painful ROM by physician.
MSUS allows the differentiation between degenerative shoulder lesions and signs of disease activity in RA and AS patients and identifies a subgroup of patients with higher disease activity that could benefit from a more aggressive treatment approach. Our study had some limitations;
• The number of individuals was relatively low. So, further studies on a bigger sample size are needed to confirm our results.
• MSUS assessment was performed by single operator so there was dependence on personal interpretation of the image, although he was blinded to clinical findings, diagnosis and patient identity.
• Quantification of synovial hypertrophy and PD vascularization was not done. So, scoring systems for gray scale abnormalities and PD vascularization as well as indices of enthesopathy should be included in future studies.
• Further studies are needed to investigate the frequency of shoulder joint enthesopathy in RA patients.
• Frequency of conjoined tendon & deltoid acrominal enthesopathy and AC joint affection in AS patients should be further explored in future studies.
• Further studies are needed to validate our logistic regression model which revealed that our predictive accuracy could be regarded as moderate for AS and poor for RA.
• The diagnostic role of MSUS should be reflected in the management plan of the patients for determining the best therapeutic modality for treating the pathology of shoulder affection either by means of rest, exercise, local injection, physical modalities or by more aggressive therapy even biologic treatment and follow up of the patients by MSUS.