Lehtinen A, Taavitsainen M, Leirisalo-Repo M
Department of Radiology, Helsinki University Central Hospital, Finland.
Clin Exp Rheumatol. 1994 Mar-Apr;12(2):143-8.
Enthesopathy is one of the features characterizing patients with spondylarthropathies. Its diagnosis is usually based on clinical symptoms such as the presence of calcanear pain or tenderness at the insertion(s) of ligaments. More objective ways to estimate the presence and nature of enthesopathy are needed. Therefore, we analysed both by clinical and sonographic methods the presence of enthesopathy in the lower extremities of patients with spondylarthropathy.
31 consecutive patients with spondylarthropathies (15 with reactive arthritis, 12 with ankylosing spondylitis, and 4 with psoriatic arthritis) were studied for the presence of enthesopathy in the lower extremities, independently by clinical examination and by high resolution sonography.
Sonography detected inflammatory lesions in 44 entheses of 20 patients. Oedema at the insertion of the tendon was the most common finding. Signs of enthesitis were more common in the lower portion of the leg. In addition to enthesitis, bursitis was a common finding by sonography. By clinical examination, enthesitis was diagnosed in 56 sites in 20 patients, most frequently at the insertions of the Achilles tendon and the plantar fascia. Bursitis around the calcaneus and synovitis/pain in the hip and knee joints were most frequently misinterpreted to indicate enthesopathy at the clinical examination. In addition, half of the insertions with only oedema at sonography were clinically asymptomatic.
Sonographic examination of ligamentous insertions offers morphologic information which is unobtainable by the clinical judgement of tenderness in the estimation of enthesopathy in patients with spondylarthropathies.
附着点病是脊柱关节病患者的特征之一。其诊断通常基于临床症状，如跟骨疼痛或韧带附着处压痛。需要更客观的方法来评估附着点病的存在及性质。因此，我们通过临床和超声检查两种方法分析了脊柱关节病患者下肢附着点病的情况。
连续纳入31例脊柱关节病患者（15例反应性关节炎、12例强直性脊柱炎和4例银屑病关节炎），分别通过临床检查和高分辨率超声独立研究下肢附着点病的情况。
超声检查在20例患者的44个附着点发现了炎性病变。肌腱附着处水肿是最常见的表现。附着点炎的体征在小腿下部更常见。除附着点炎外，滑囊炎也是超声检查常见的表现。通过临床检查，在20例患者的56个部位诊断出附着点炎，最常见于跟腱和足底筋膜附着处。临床检查时，跟骨周围滑囊炎以及髋关节和膝关节滑膜炎/疼痛最常被误诊为附着点病。此外，超声检查仅发现水肿的附着点中有一半在临床上无症状。
对于脊柱关节病患者附着点病的评估，韧带附着处的超声检查可提供临床压痛判断无法获得的形态学信息。
