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2015 ; 15
(61
): 196-207
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Enthesopathies and enthesitis Part 2: Imaging studies
#MMPMID26672488
Sudo?-Szopi?ska I
; Kwiatkowska B
; Prochorec-Sobieszek M
; Praco? G
; Walentowska-Janowicz M
; Ma?li?ski W
J Ultrason
2015[Jun]; 15
(61
): 196-207
PMID26672488
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The pathologies of tendon and ligament attachments are called enthesopathies.
Enthesitis is one of enthesopathies and it is considered a characteristic sign of
rheumatic diseases from the spondyloarthritis group, including peripheral
spondyloarthritis. Therefore, enthesitis has been included in a number of
clinical classifications for diagnosing these diseases. Clinical diagnosis of
enthesitis is based on rather non-specific clinical signs and results of
laboratory tests. It is believed that imaging examinations might improve
diagnosis, particularly because numerous papers prove that differentiating
enthesitis from other enthesopathic processes is possible. On the other hand, a
number of authors report the lack of specific signs in imaging as well as typical
histological and immunological features that would enable confirmation of
clinical diagnosis of enthesitis. The first part of the publication presented
theories on the etiopathogenesis of enthesitis (inflammatory, mechanical,
autoimmune and associated with the synovio-entheseal complex) as well as on the
formation of enthesophytes (inflammatory, molecular and mechanical). This paper -
the second part of the article, is a review of the state-of-the-art on the
ability of imaging examinations to diagnose enthesitis. It turns out that none of
the enthesitis criteria used in imaging examinations is specific for
inflammation. As enthesitis may be the only symptom of early spondyloarthritis
(particularly in patients with absent HLA-B27 antigen), the lack of its
unambiguous picture in ultrasound and magnetic resonance imaging prompts the
search for other signs characteristic of spondyloarthritis and more specific
features in imaging in order to make a diagnosis as early as possible.
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