Achilles enthesitis ultrasound

We are using cookies to give you the best experience on our site. Part of Springer Nature. 8%) had PD signal. Therefore it is highly likely that some cases of enthesitis-related disease are being missed, misdiagnosed and not referred to rheumatologists. It also involves larger entheses e. It thus applies to disease associated with the spondyloarthritides (SpA) including ankylosing spondylitis, psoriatic arthritis, reactive arthritis and undifferentiated SpA. The Achilles enthesis takes its name from the ill fated Greek hero of the same name. We aimed to investigate the potential of ultrasonography (US) to detect early changes after TNF-α antagonist therapy of Achilles enthesis of AS patients.

Enthesitis is the term used to describe inflammation at tendon, ligament or joint capsule insertions. US of the Achilles tendon was performed bilaterally. Grey-scale (GS) and power Doppler (PD) scores on a 5–7 semi-quantitative scale and total additive scores (TS) were calculated. Achilles enthesitis ultrasound. By continuing to use our website without changing the settings, you are agreeing to our use of cookies. Cookies are files stored in your browser and are used by most websites to help personalise your web experience. Swelling may, however, be a prominent feature at large insertions in the lower limbs. Heel and foot pain represent common reasons for referral into podiatry and physiotherapy services. Doi: 65.6598/rheumatology/kep965 Objective. Although the SpA are truly inflammatory disorders, the enthesis is a relatively avascular structure and inflammatory markers, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), may not be elevated in the presence of entheseal-related pathologies.

The role of injury or trauma as a trigger for enthesitis is still unclear. Forty-three AS patients with active disease, requiring TNF-α antagonist therapy, were included.
Features compatible with achilles tendon enthesopathy. In addition to being clinically recognised at the Achilles enthesis and patellar tendon insertions, this pattern of disease is well recognised at the plantar fascia, the elbow epicondyles, other insertions about the knees, spinous processes of the vertebrae and at other sites, including the iliac crest. 5) vs 7. Therapeutic effects of TNF-α antagonist treatments for enthesitis on imaging changes are still limited to case reports or small sample-sized trials. The sizable spur at the Achilles tendon insertion is confirmed. 7567 Springer International Publishing AG. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), ESR and CRP levels also showed significant improvements. 7), P 5.556 and 9.

Achilles tendon insertion more often than smaller ones. A Professional Resource for Patients and Doctors Relating to Disorders of the Enthesis Follow-up US examinations were performed 7 months after the initiation of therapy. Cong-hua Wang, Yuan Feng, Zhen Ren and Xichao Yang contributed equally to this work.  problems are not uncommon in athletes and patients over 85 years old. Methods. GS score and TS decreased significantly [8. There is also a calcaneal spur at the plantar fascia origin and other findings (Eduardo Ira radiographer, Dr. Gary Geier radiologist). In general enthesitis is more common in the lower limbs compared to the upper limbs. Physical examination was performed to detect Achilles enthesitis and/or retrocalcaneal bursitis.

G. This is best exemplified in the inflammatory back pain that accompanies ankylosing spondylitis, where undoubted inflammatory activity is not necessarily associated with elevation of inflammatory markers. Conclusions.
Usually it is affected between 8-6 cm from its attachment to the heel (  or ), or it may be affected at it's attachment to the calcaneus ( ). Results. 9) vs 7. Generally this type of enthesitis is recognised in conjunction with other features of SpA including synovial joint swelling, dactylitis or axial disease (all of which have an entheseal-associated or entheseal-based pathology on imaging). In addition to standard outcome measures, US might be an additional useful tool to monitor therapy in SpA patients with Achilles enthesitis. The term enthesopathy, however, has a wider meaning and designates all pathological abnormalities of insertions including inflammatory changes and degenerative problems. Enthesitis most frequently presents as pain, stiffness and tenderness of insertions without much swelling. 8), P 5.556, respectively], whereas the decrease in PD score was not significant after 7 months of follow-up. Enthesitis is considered as the primary anatomical lesion in ankylosing spondylitis (AS).
Subclinical Achilles enthesitis, detected only with GS US, is present in a subset of AS patients and a significant improvement can be demonstrated after 7 months of TNF-α antagonist therapy. In the absence of joint swelling, enthesitis may thus be difficult to recognise.

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