McGonagle Dennis, Abacar Kerem, Kirkham Bruce
D. McGonagle, MD, PhD, K. Abacar, MD, Leeds Institute of the Rheumatic and Musculoskeletal Diseases, and Leeds Teaching Hospitals NHS Trust, Leeds;
D. McGonagle, MD, PhD, K. Abacar, MD, Leeds Institute of the Rheumatic and Musculoskeletal Diseases, and Leeds Teaching Hospitals NHS Trust, Leeds.
J Rheumatol. 2024 Oct 1;51(Suppl 2):101-105. doi: 10.3899/jrheum.2024-0593.
The enthesitis hypothesis posits that enthesitis is a primary lesion and that inflammation at the enthesis initiates the musculoskeletal symptoms of psoriatic arthritis (PsA) and spondyloarthropathies (SpA). The hypothesis suggested that inflamed entheseal tissue near the synovium could trigger cytokine-mediated synovitis, that enthesis bone anchorage could explain osteitis, and that the location of entheses at the soft tissue interface could explain dactylitis. Advances in imaging techniques that allow better visualization of enthesitis lesions and the development of animal models have allowed evolution of the concept of enthesitis as a central mechanistic driver of musculoskeletal symptoms in PsA and SpA. A debate between Drs. Dennis McGonagle and Bruce Kirkham at the Group for Research on Psoriasis and Psoriatic Arthritis (GRAPPA) 2023 annual meeting discussed the data supporting and refuting this hypothesis in PsA and SpA, respectively. The major points of this debate are summarized in this article.
附着点炎假说认为，附着点炎是一种原发性病变，附着点处的炎症引发银屑病关节炎（PsA）和脊柱关节炎（SpA）的肌肉骨骼症状。该假说提出，滑膜附近发炎的附着点组织可引发细胞因子介导的滑膜炎，附着点的骨锚固可解释骨炎，且附着点在软组织界面的位置可解释指（趾）炎。能够更好地显示附着点炎病变的成像技术进展以及动物模型的开发，使得附着点炎作为PsA和SpA肌肉骨骼症状的核心机制驱动因素这一概念得以演变。丹尼斯·麦戈纳格尔博士和布鲁斯·柯克汉姆博士在银屑病和银屑病关节炎研究小组（GRAPPA）2023年年会上展开了一场辩论，分别讨论了支持和反驳PsA和SpA中这一假说的数据。本文总结了这场辩论的要点。
