D'Agostino Maria Antonietta, Olivieri Ignazio
Rheumatology Department, Ambroise Paré Hospital, UVSQ University, Boulogne-Billancourt, France.
Best Pract Res Clin Rheumatol. 2006 Jun;20(3):473-86. doi: 10.1016/j.berh.2006.03.007.
Enthesitis is a distinctive pathological feature of spondyloarthritis and may involve synovial joints, cartilaginous joints, syndesmoses and extra-articular entheses. This review focuses on peripheral extra-articular enthesitis, which is a clinical hallmark of spondyloarthritis. The entheses of the lower limbs are more frequently involved than those of the upper limbs, and heel enthesitis is the most frequent. Entheseal pain may be mild or moderate as well as severe and disabling. Peripheral enthesitis may be observed in all forms of spondyloarthritis, including the undifferentiated forms, and may, for a prolonged period, be the only longstanding clinical manifestation of the B27-associated disease process. The conceptual understanding of spondyloarthritis and the ability to image sites of skeletal inflammation accurately, i.e. ultrasound and magnetic resonance imaging, confirm that enthesitis is the primary lesion of spondyloarthritis. This advance has been occurring simultaneously with the therapeutic advances in spondyloarthritis due to the introduction of anti-tumour necrosis factor-alpha agents.
附着点炎是脊柱关节炎的一个显著病理特征，可能累及滑膜关节、软骨关节、韧带联合和关节外附着点。本综述聚焦于外周关节外附着点炎，它是脊柱关节炎的一个临床标志。下肢的附着点比上肢更常受累，足跟附着点炎最为常见。附着点疼痛可能轻微、中度，也可能严重到致残。外周附着点炎可见于所有形式的脊柱关节炎，包括未分化形式，并且在很长一段时间内可能是B27相关疾病过程的唯一长期临床表现。对脊柱关节炎的概念理解以及准确成像骨骼炎症部位的能力，即超声和磁共振成像，证实附着点炎是脊柱关节炎的主要病变。由于引入了抗肿瘤坏死因子-α药物，这一进展与脊柱关节炎的治疗进展同时出现。
