Enthesopathy

Purpose of reviewRecognition of the importance of enthesitis as the pivotal pathological process underpinning spondyloarthropathies (SpA) has increased in recent years. Thus, we summarized the current knowledge on the pathogenic role of enthesitis on SpA shown by both animal models and human studies in vivo.Recent findingsExperimental models have shown several SpA-like diseases that commence at entheses and are linked to nail disease as well as dactylitis, two important entheseal-associated conditions in humans. Frequently, enthesitis is not the primary outcome measure in studies of peripheral PsA and SpA although arguably it is the key parameter being indirectly assessed in spinal disease in ankylosing spondylitis. The use of different agents including JAK, IL-17, and IL-23 inhibitors contributes significantly to our understanding of enthesitis in terms of involved immune pathways. Enthesitis and enthesis organ inflammation may be the primary pathological process underlying SpA associated skeletal inflammation. Emergent studies are beginning to elucidate the molecular basis for this type of joint inflammatory response.

Purpose of reviewTo describe the recent advances in the field towards the prevention and early recognition of Psoriatic Arthritis (PsA).Recent findingsDefining the preclinical phase of PsA remains challenging since up to 50% of subjects with psoriasis have subclinical imaging enthesopathy, but many of these do not progress to PsA. Nevertheless, there is evidence that subjects with subclinical imaging enthesopathy are at increased risk of developing PsA. In recent years, it has been shown that both PsA and anti-citrullinated protein antibodies (ACPA) positive rheumatoid arthritis (RA) are characterized by a subclinical phase of non-specific or brief duration arthralgia with shared imaging features accounting for joint symptomatology. Sonographically determined tenosynovitis and enthesitis are the key imaging features present in non-specific PsO arthralgia that are at risk of future PsA development. Furthermore, the early phases of PsA are complicated by factors including body mass index (BMI), which is a risk factor for PsA, but BMI is also associated with imaging abnormalities on enthesopathy. Fully disentangling these clinical and imaging factors will be important for enrichment for imminent PsA so that disease prevention strategies can be investigated. Psoriasis patients with arthralgia have a higher prevalence of tenosynovitis and imaging enthesopathy is at higher risk of transitioning to overt PsA.

BackgroundTo examine the association between sonographic enthesitis and the severity of radiographic features of damage in the peripheral and axial joints in psoriatic arthritis (PsA).MethodsA cross-sectional analysis was conducted in patients with PsA. The MAdrid Sonography Enthesitis Index (MASEI) scoring system was used to quantify the extent of sonographic entheseal abnormalities. Radiographic damage in the peripheral joints and spine was assessed by the modified Steinbrocker score (mSS), Modified New York Criteria for sacroiliitis, and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The association between MASEI and the extent of radiographic damage was assessed using negative binomial and logistic regression. The results were expressed in terms of the regression coefficient estimates and their exponentiated values (eβ) or odds ratios (OR), and 95% confidence intervals (CI).ResultsTwo hundred and twenty three patients were analyzed; 58% were males, with mean ± SD age of 55.9 ± 12.9 years and PsA duration of 16.7 ± 12.4 years. Regression analyses yielded an association between higher MASEI scores (10 units increase) and peripheral joint damage including mSS (eβ = 1.42, 95% CI: 1.15, 1.72), joint ankylosis (OR = 1.93, 95% CI: 1.37, 2.72), arthritis mutilans (OR = 1.77, 95% CI: 1.23, 2.54), and periostitis (OR = 1.41, 95% CI: 1.08, 1.84). Similarly, an association was found between higher MASEI scores and axial damage as measured by mSASSS (eβ = 2.18, 95% CI: 1.16, 4.09) and sacroiliitis (OR = 1.33, 95% CI: 1.03, 1.72).ConclusionsThe severity of sonographic enthesitis is a potential marker of radiographic peripheral and axial joint damage in PsA.

ObjectiveMusculoskeletal complications represent a significant burden in diabetes, yet the distinct presentation between Type 1 (T1DM) and Type 2 Diabetes Mellitus (T2DM) remains under-characterized. This study aimed to evaluate and quantify the burden of rheumatic manifestations and subclinical enthesopathy in these two distinct clinical phenotypes.MethodsWe conducted a cross-sectional analysis of 65 patients (21 T1DM, 44 T2DM). A comprehensive rheumatological evaluation assessed adhesive capsulitis (defined as painful restriction of active and passive motion in ≥ 2 planes), knee osteoarthritis (per American College of Rheumatology clinical classification criteria), cheiroarthropathy, and soft tissue rheumatism. High-resolution musculoskeletal ultrasound evaluated five bilateral entheseal sites using the Glasgow Ultrasound Enthesitis Scoring System (GUESS). Effect sizes (Cohen's d) and 95% Confidence Intervals (CI) were calculated to assess the magnitude of intergroup differences.ResultsThe T2DM phenotype was characterized by older age and higher BMI compared to T1DM. T2DM patients exhibited a markedly higher prevalence of adhesive capsulitis, knee osteoarthritis, and anserine bursitis. Ultrasound revealed a substantially higher enthesopathy burden in the T2DM group, with a mean GUESS score of 6.8 ± 2.1 compared to 1.1 ± 0.2 in T1DM. The effect size for the difference in enthesopathy scores (Cohen's d = 3.29) exceeded the effect size for the age difference (d = 2.79), suggesting that the observed structural burden may not be fully explained by age alone. Available HbA1c data showed similarly suboptimal glycemic control in both groups.ConclusionT2DM was associated with a higher burden of structural entheseal abnormalities and higher GUESS scores compared with T1DM. These findings may reflect the combined influence of obesity, metabolic factors, and age. Interpretation should consider baseline demographic differences between groups and the broad clinical definitions employed.