Watad Abdulla, Eshed Iris, McGonagle Dennis
Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2017 Nov;19(11):708-711.
Enthesitis is a term that refers to inflammation at tendon, ligament, or joint capsule insertions. The entheses are increasinlgly considered to be the primary site of joint inflammation in the spondyloarthropathies including psoriatic arthritis (PsA). Great advances have occurred in the understanding of enthesopathy, which has resulted in a better understanding of the etiopathogenesis of PsA. Enthesitis is difficult to assess on both clinical examination and on imaging because of the overlap in features between mechanical, degenerative, and inflammatory pathologies. Ultrasonography frequently detects entheseal abnormalities in patients with psoriasis, despite the absence of clinical symptoms of arthropathy and the longitudinal value of such lesions for PsA prediction remains unknown. The role of magnetic resonance imaging (MRI) in the assessment and monitoring of enthesitis is not fully agreed on but it is clearly superior for the assessment of spinal polyenthesitis and for diffuse peri-enthseal osteitis that can occur anywhere in the skeleton. Nuclear medicine, including conventional positron-emission tomography (PET) and high-resolution PET scan (hrPET), is more of a research tool for enthesitis and can, for example, help distinguish between PsA and osteoarthritis. Entheseal abnormalities are common in osteoarthritis, which creates diagnostic difficulty from PsA. Entheseal changes, especially on imaging, may also occur in rheumatoid arthritis (RA) and likely reflect the extension of the inflammatory process from the adjacent synovium. The nail is anatomically anchored to the skeleton via a mini-enthesis network. An association between ultrasonography determined distal interphalageal joint (DIP) extensor tendon enthesopathy and clinical nail disease was found, which highlights the pivotal role of the enthesis in this PsA risk factor. This review summarizes the relevant insights and implication of imaging for enthesitis, primarily in PsA but also in other arthropathies.
附着点炎是一个术语，指肌腱、韧带或关节囊附着处的炎症。附着点越来越被认为是包括银屑病关节炎（PsA）在内的脊柱关节炎中关节炎症的主要部位。在附着点病的认识方面已经取得了巨大进展，这使得对PsA的病因发病机制有了更好的理解。由于机械性、退行性和炎症性病变的特征存在重叠，附着点炎在临床检查和影像学检查中都难以评估。超声检查经常能在银屑病患者中检测到附着点异常，尽管这些患者没有关节病的临床症状，而且此类病变对PsA预测的纵向价值仍不清楚。磁共振成像（MRI）在附着点炎评估和监测中的作用尚未完全达成共识，但它在评估脊柱多附着点炎和可发生于骨骼任何部位的弥漫性附着点周围骨炎方面明显更具优势。核医学，包括传统的正电子发射断层扫描（PET）和高分辨率PET扫描（hrPET），更多地是一种用于附着点炎的研究工具，例如可以帮助区分PsA和骨关节炎。附着点异常在骨关节炎中很常见，这给与PsA的鉴别诊断带来了困难。附着点改变，尤其是在影像学上，也可能出现在类风湿关节炎（RA）中，可能反映了炎症过程从相邻滑膜的扩展。指甲通过一个微型附着点网络在解剖学上与骨骼相连。发现超声检查确定的远端指间关节（DIP）伸肌腱附着点病与临床指甲疾病之间存在关联，这突出了附着点在这个PsA危险因素中的关键作用。本综述总结了影像学对附着点炎的相关见解及影响，主要针对PsA，但也涉及其他关节炎。
