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2015 ; 15
(60
): 72-84
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Enthesopathies and enthesitis Part 1 Etiopathogenesis
#MMPMID26674568
Sudo?-Szopi?ska I
; Kwiatkowska B
; Prochorec-Sobieszek M
; Ma?li?ski W
J Ultrason
2015[Mar]; 15
(60
): 72-84
PMID26674568
show ga
The pathologies of tendon and ligament attachments are called enthesopathies. One
of its types is enthesitis which is a characteristic sign of peripheral
spondyloarthropathy. Clinical diagnosis of enthesitis is based on rather
non-specific clinical signs and results of laboratory tests. Imaging examinations
are highly promising. Numerous publications prove that enthesitis can be
differentiated from other enthesopathic processes in an ultrasound examination or
magnetic resonance imaging. However, some reports indicate the lack of
histological criteria, specific immunological changes and features in imaging
examinations that would allow the clinical diagnosis of enthesitis to be
confirmed. The first part of the publication presents theories on the
etiopathogenesis of enthesopathies: inflammatory, mechanical, autoimmune, genetic
and associated with the synovio-entheseal complex, as well as theories on the
formation of enthesophytes: inflammatory, molecular and mechanical. The second
part of the paper is a review of the state-of-the-art on the ability of imaging
examinations to diagnose enthesitis. It indicates that none of the criteria of
inflammation used in imaging medicine is specific for this pathology. As
enthesitis may be the only symptom of early spondyloarthropathy (particularly in
patients with absent HLA-B27 receptor), the lack of its unambiguous picture in
ultrasound and magnetic resonance scans prompts the search for other signs
characteristic of this disease and more specific markers in imaging in order to
establish diagnosis as early as possible.
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