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Psoriatic Arthritis
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
Elena Ciofoaia, Ana-Maria Orbai, Jason Liebowitz
Enthesitis is defined as inflammation at the site of tendon and ligament insertion into bone. It is a feature of all the spondyloarthropathies and may be a presenting feature in PsA. Enthesitis can be seen in up to 50% of patients with PsA and is hypothesized to be the site of disease initiation (Dubash et al., 2020). The clinical examination of the entheses records entheseal point tenderness and may be overestimating entheseal tenderness in patients with concomitant fibromyalgia or pain sensitization. Agreement between ultrasound-diagnosed enthesitis and clinical enthesitis is very low (Yamada et al., 2021; Michelsen et al., 2017). Interrater reliability of clinical enthesitis indices was low even when standardized examination techniques were used; thus, determining the true prevalence of enthesitis in PsA is challenging (Ogdie, 2015). The most common entheseal sites involved are the Achilles tendon and plantar fascia insertions. Other sites of involvement include the insertions of the quadriceps and patellar tendons, the iliac crest, the rotator cuff, and the epicondyles at the elbow. There is overlap between the anatomical enthesitis lesion and dactylitis such that enthesitis is a component of dactylitis. Indeed, ultrasound-proven enthesitis has also been associated with disease severity and radiographic progression (Eder & Aydin, 2018).
Rheumatology
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
The joint pain described is typically inflammatory sounding, e.g. ‘morning stiffness which eases with activity’. Patients may complain of joint pain or swelling or pain around the ligament attachments to bone (enthesitis).
Inflammatory Responses Acquired Following Environmental Exposures Are Involved in Pathogenesis of Musculoskeletal Pain
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
Ritchie C. Shoemaker, James C. Ryan
McGonagle [70] has looked in detail at psoriatic arthritis concluding that the arthritic pain in association with nail findings is actually clinically unrecognized enthesitis. He notes enthesitis is “associated with adjacent osteitis or bone and synovial inflammation.” Normal insertion of tendons in McGonagle’s view are associated with micro-damage and inflammatory change, strongly suggesting “that local tissue specific or what has been described as auto-inflammatory factors, may dictate disease expression.”
Tailored biological treatment for patients with moderate-to-severe psoriasis
Published in Expert Review of Clinical Immunology, 2023
Martina Maurelli, Paolo Gisondi, Giampiero Girolomoni
PsA is the major comorbidity associated with psoriasis characterized by the involvement of different musculoskeletal domains. The prevalence of PsA is around one-third of Caucasian patients with psoriasis, ranging between 6% and 42%, and is highest among patients between 30 and 60 years. The majority of patients first develop psoriasis and only later develop PsA by a median of 8 years, although in 15% of cases, PsA and psoriasis occur simultaneously or PsA precedes cutaneous disease. In many cases, PsA is a mild-to-moderate disease with a fluctuating course, but the risk of development of bone erosion with a disabling form of arthritis is high. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recognized different domains of PsA to suggest a more appropriate treatment to reach the lowest disease activity in each domain. These include peripheral arthritis, axial disease, enthesitis, dactylitis, skin disease, and nail disease. Enthesitis can be found in 30–50% of patients and affects generally the plantar fascia and Achilles’ tendon, causing pain around patella, iliac crest and epicondyles. Dactylitis is observed in 40–50% of patients, involving asymmetrically particularly the third and fourth toes, but also other toes and hands [8–11].
Prevalence of joint, entheseal, tendon, and bursal findings in young, healthy individuals by musculoskeletal ultrasound
Published in Scandinavian Journal of Rheumatology, 2023
JK Schreiner, D Scheicht, P Karakostas, F Recker, J Ziob, C Behning, P Preuss, P Brossart, VS Schäfer
Despite this attempt to allow for more precise comparison of ultrasound findings, appropriate interpretation of musculoskeletal ultrasound results in young patients may continue to be problematic in clinical practice. The frequency of ultrasound findings of joints, entheses, tendons, and bursae in young, healthy individuals has not been extensively studied, resulting in a lack of knowledge about incidental findings in grey-scale (GS) and PD ultrasound examination. One study focused on synovial inflammatory findings in small joints of the wrist and foot, as they are frequently affected by RA (6). Another prospective study analysed the prevalence of elbow joint arthritis and enthesitis in both RA patients and healthy controls (7), while several studies concentrated on the impact of physical activity on entheseal findings in athletes (8–10). Preliminary data on ultrasound results have been published, showing the influence of mechanical stress on the hands in volleyball players (11). In addition, an association between the body mass index (BMI) and entheseal ultrasound findings representing inflammation and damage was observed in a cohort of healthy individuals (12).
The impact of coexisting fibromyalgia syndrome on disease activity in patients with psoriatic arthritis and rheumatoid arthritis: A cross-sectional study
Published in Modern Rheumatology, 2021
Cevriye Mülkoğlu, F. Figen Ayhan
Bello et al. used FiRST for the diagnosis of FMS in 196 patients with SpA and detected the presence of accompanying FMS in 42 (21.4%) of the cases. They divided patients to two groups, one with FMS and the other without FMS. In that study, the patients with accompanying FMS were also identified as those with more enthesitis and significantly higher disease activity scores (BASDAI) and VAS [9]. Similarly, in present study, we found a statistically significant correlation between FiRST score and DAS28, BASDAI scores in patients with PsA. In another study of 73 patients with PsA, the patients with accompanying FMS had disease activity scores twice as high as those without FMS (BASDAI, DAS28, and Leeds Enthesitis Index) [33]. Enthesitis is a common feature of diseases in the SpA group (35% prevalence in PsA). Enthesitis is inflammation of the entheses, the sites where tendons or ligaments insert into the bone [34], which is extremely difficult to distinguish from FMS. There is an overlap between enthesitis in PsA and tender points in FMS, making it difficult to distinguish between these two conditions. On the other hand, tender points have been traditionally used to diagnose FMS [20]. Since tender points are critical for the diagnosis of FMS, the other diagnostic methods such as ultrasonography or magnetic resonance imaging might be used to detect inflammatory disease like enthesitis.