Department of Medicine, Division of Rheumatology and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust & The University of Leeds, Leeds, United Kingdom.
Curr Opin Rheumatol. 2021 Jan;33(1):64-73. doi: 10.1097/BOR.0000000000000768.
Despite immunology and translational therapeutics advances in inflammatory arthritis over the past two decades, the enthesis, which is the epicentric of the spondyloarthritis family pathological process, retains many mysteries because of tissue inaccessibility that hampers direct immune study. As entheses are subject to almost continuous mechanical stress and spondyloarthritis is linked to microdamage or injury and joint stress, it is cardinal to understand the physiological changes occurring within the entheses not only to be able to differentiate disease from health but also to understand the transition normal physiology break down and its merges into spondyloarthritis-related disease.
Imaging has played a major role in understanding the enthesis in human. Remarkable insights from enthesis functioning and microdamage in normal and with ageing including those linked to body mass index is emerging. The impact of mechanical stress and degenerative conditions on the development of the secondary entheseal vascular changes is not understood. Of note, ultrasound studies in psoriasis have shown higher power Doppler changes compared to controls pointing towards a role for vascular changes in the development of enthesitis in psoriatic arthritis.
The literature pertaining to normal entheses changes with age, microdamage and vascular changes in health is providing a roadmap for understanding of the enthesis and its potential role in evolution of spondyloarthritis including psoriatic arthritis.
尽管过去二十年来炎症性关节炎在免疫学和转化治疗方面取得了进展，但由于附着点组织难以接近，阻碍了直接免疫研究，附着点仍然存在许多未解之谜。附着点承受着几乎持续的机械应力，而脊柱关节炎与微损伤或损伤以及关节应力有关，因此了解附着点内发生的生理变化至关重要，不仅能够将疾病与健康区分开来，还能够了解正常生理的转变及其与脊柱关节炎相关疾病的融合。
影像学在理解人类附着点方面发挥了重要作用。正常和老化过程中附着点功能和微损伤的显著见解正在浮现，包括与体重指数相关的见解。机械应力和退行性疾病对次级附着点血管变化发展的影响尚不清楚。值得注意的是，银屑病的超声研究显示与对照组相比，功率多普勒变化更高，这表明血管变化在银屑病关节炎附着点炎的发展中起作用。
关于健康附着点的正常变化、微损伤和血管变化的文献为理解附着点及其在包括银屑病关节炎在内的脊柱关节炎演变中的潜在作用提供了路线图。
