Paolaggi J B
Service de Rhumatologie, Hôpital Ambroise Paré, Boulogne.
Bull Acad Natl Med. 1997 Jun-Jul;181(6):1119-40; discussion 1140-2.
Our studies concerning enthesopathies during the course of spondylarthropathies show that enthesopathies are very frequent: 58% among 48 spondylarthropathies in a preliminary study. The comparison of the frequency of enthesopathies in spondylarthropathies (58%) and in Rheumatoid Arthritis (6.6%) show a highly significant difference. In our latest study enthesopathies were found in 67% among 115 spondylarthropathies. We have also described the mean locations and clinical features. They are observed early in the course of the disease. Histological studies of enthesopatic and normal enthesis were also performed. They were unable to find a specific image. Nevertheless inflammatory changes in some of our cases and in cases retrieved in the medical literature confirm the involvement of enthesis in the pathological process of spondylarthropathies. Enthesopathies represent a very good diagnostic symptom. They are the hallmark of spondylarthropathies for adults and even more for children. Furthermore, if one admits the assertion that peripheral and spinal involvement is the result of bone remodeling enthesitic lesions, then enthesopathies and osteitis, ending in ankylosis, may be considered as the fundamental pathophysiological mechanism of spondylarthropathies in contrast with erosive lesions of rheumatoid arthritis.
我们关于脊柱关节病病程中附着点病的研究表明，附着点病非常常见：在一项初步研究的48例脊柱关节病中占58%。脊柱关节病中附着点病的发生率（58%）与类风湿关节炎中附着点病的发生率（6.6%）相比，差异极为显著。在我们的最新研究中，115例脊柱关节病中有67%发现了附着点病。我们还描述了其常见部位和临床特征。它们在疾病早期即可观察到。我们还对附着点病和正常附着点进行了组织学研究。未发现特异性图像。然而，我们的一些病例以及医学文献中检索到的病例中的炎症改变证实了附着点参与了脊柱关节病的病理过程。附着点病是一个很好的诊断症状。它们是成人脊柱关节病的标志，对儿童而言更是如此。此外，如果承认外周和脊柱受累是骨重塑附着点病变的结果，那么与类风湿关节炎的侵蚀性病变相比，附着点病和骨炎最终导致关节强直，可能被视为脊柱关节病的基本病理生理机制。
