Enthesitis

Enthesitis
Typical Joint showing Enthesis
Classification and external resources
DiseasesDB	18256

Enthesitis is inflammation of the entheses, the sites where tendons or ligaments insert into the bone.^[1][2] It is also called enthesopathy, or any pathologic condition involving the entheses. The entheses are any point of attachment of skeletal muscles to the bone, where recurring stress or inflammatory autoimmune disease can cause inflammation or occasionally fibrosis and calcification. One of the primary entheses involved in inflammatory autoimmune disease is at the heel, particularly the Achilles tendon.

It is associated with HLA B27 arthropathies like ankylosing spondylitis, psoriatic arthritis, and reactive arthritis.^[3][4] Symptoms include multiple points of tenderness at the heel, tibial tuberosity, iliac crest, and other tendon insertion sites.

Images

Sagittal magnetic resonance images of ankle region: psoriatic arthritis. (a) Short tau inversion recovery (STIR) image, showing high signal intensity at the Achilles tendon insertion (enthesitis, thick arrow) and in the synovium of the ankle joint (synovitis, long thin arrow). Bone marrow oedema is seen at the tendon insertion (short thin arrow). (b,c) T1 weighted images of a different section of the same patient, before (panel b) and after (panel c) intravenous contrast injection, confirm inflammation (large arrow) at the enthesis and reveal bone erosion at tendon insertion (short thin arrows).

Sources

1. Maria Antonietta D'Agostino, MD; Ignazio Olivieri, MD (June 2006). "Enthesitis". 20 (3). Clinical Rheumatology: 473–486. doi:10.1016/j.berh.2006.03.007.
2. The Free Dictionary (2009). "Enthesitis". Retrieved 2010-11-27.
3. Bauman C, Cron RQ, Sherry DD, Francis JS (March 1996). "Reiter syndrome initially misdiagnosed as Kawasaki disease". The Journal of Pediatrics. 128 (3): 366–9. doi:10.1016/S0022-3476(96)70283-4. PMID 8774506.
4. American College of Physicians. Medical Knowledge Self-Assessment Program (MKSAP-15): Rheumatology. "The Seronegative Spondyloarthropathies." 2009, ACP. Pg. 29-30.

Information resource at www.enthesis.info