Fasciitis

Eosinophilic fasciitis (EF), defined as diffuse fasciitis with eosinophilia by Shulman in 1974, is a disease with unknown etiology and whose pathogenesis is still being researched. The diagnosis is based on the clinical aspects (skin induration with an "orange peel" appearance), the lab results (eosinophilia, increased inflammatory markers), the skin biopsy with the pathognomonic histopathological result, as well as the typical MRI changes. The treatment includes glucocorticoids and immunosuppressive drugs. Due to severe refractory cases, the treatment remains a challenge. EF is still a disease with potential for further research.

BackgroundMedical imaging can be used to assist with the diagnosis of plantar heel pain. The aim of this study was to synthesise medical imaging features associated with plantar heel pain.MethodsThis systematic review and meta-analysis conducted searches in MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to 12th February 2021. Peer-reviewed articles of cross-sectional observational studies written in English that compared medical imaging findings in adult participants with plantar heel pain to control participants without plantar heel pain were included. Study quality and risk of bias was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Sensitivity analyses were conducted where appropriate to account for studies that used unblinded assessors.ResultsForty-two studies (2928 participants) were identified and included in analyses. Only 21% of studies were rated 'good' on quality assessment. Imaging features associated with plantar heel pain included a thickened plantar fascia (on ultrasound and MRI), abnormalities of the plantar fascia (on ultrasound and MRI), abnormalities of adjacent tissue such as a thickened loaded plantar heel fat pad (on ultrasound), and a plantar calcaneal spur (on x-ray). In addition, there is some evidence from more than one study that there is increased hyperaemia within the fascia (on power Doppler ultrasound) and abnormalities of bone in the calcaneus (increased uptake on technetium-99 m bone scan and bone marrow oedema on MRI).ConclusionsPeople with plantar heel pain are more likely to have a thickened plantar fascia, abnormal plantar fascia tissue, a thicker loaded plantar heel fat pad, and a plantar calcaneal spur. In addition, there is some evidence of hyperaemia within the plantar fascia and abnormalities of the calcaneus. Whilst these medical imaging features may aid with diagnosis, additional high-quality studies investigating medical imaging findings for some of these imaging features would be worthwhile to improve the precision of these findings and determine their clinical relevance.

BackgroundTendinopathy is a growing global concern affecting many people, like athletes, workers, and the elderly. Despite its commonality among the sporting population, there is no practical clinical guideline for patellar tendinopathy (PT). Furthermore, there is conflicting evidence between clinical guidelines on shockwave therapy's application and clinical utility for Achilles tendinopathy (AT) and plantar fasciitis (PF). Thus, our aim of this study is to evaluate the evidence for shockwave therapy; to provide a Grading of Recommendation, Assessment, Development and Evaluation (GRADE) level of the evidence and effectiveness of shockwave therapy for patellar tendinopathy, Achilles tendinopathy, and Plantar fasciitis.MethodMedical Literature Analysis and Retrieval System Online (Medline), Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro) and China National Knowledge Infrastructure database (CNKI) were searched to find relevant studies published before December 14th, 2022.ResultsOur study showed that for PT in the short term, extracorporeal shockwave therapy (ESWT) or ESWT + eccentric exercise (EE) has a negligible effect on pain and function compared to a placebo or placebo + EE. On the contrary, ESWT significantly affects pain compared to conservative treatment (CT). For AT, ESWT has a small inconclusive effect on pain and function in the short term compared to EE. On the other hand, a placebo outperformed ESWT in improving function for AT but not pain outcomes. PF showed that ESWT significantly affects short- and long-term pain and function. When ESWT was compared to other interventions such as low laser therapy (LLLT), corticosteroid injection (CSI), or CT, there was a small inconclusive effect on pain and function in the short term.ConclusionThere is low-moderate evidence that ESWT has a negligible effect on pain and function for PT and AT. However, high-quality evidence suggests ESWT has a large effect on pain and function for PF.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023396835, identifier CRD42023396835.

BackgroundEosinophilic Fasciitis (EF) is a rare immune-mediated fibrosing disorder of the fascia. Immune Checkpoint Inhibitors (ICIs) have transformed oncologic therapy but may precipitate immune-related Adverse Events (irAEs), including dermatologic and rheumatologic manifestations. ICI-associated EF has been increasingly reported, yet remains poorly characterized.ObjectiveTo systematically summarize the clinical features, diagnostic approaches, management strategies, and outcomes of ICI-associated EF.MethodsA systematic review was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, EMBASE, and Web of Science were searched from inception through January 2026. Eligible studies were case reports, case series, or observational studies describing adult cancer patients who developed EF temporally associated with ICI therapy. Two reviewers independently screened studies, extracted data, and assessed methodological quality using Joanna Briggs Institute tools.ResultsAmong 148 records identified, 93 remained after removal of 55 duplicates; 28 full-text articles were assessed and 18 met inclusion criteria, representing 22 unique patients. Nivolumab and pembrolizumab were the most frequently implicated agents. EF onset ranged from several weeks to months after ICI initiation. The most commonly affected regions were the extremities. Diagnosis was confirmed by histopathology and/or imaging in most cases. Systemic corticosteroids were the main treatment, with additional immunosuppressive agents used in selected patients. Most cases showed partial or complete clinical improvement.Study limitationsEvidence is limited to case reports and small case series, with heterogeneous reporting, precluding incidence estimation and limiting generalizability.ConclusionsICI-associated EF is a rare but clinically relevant irAE with dermatologic and connective tissue involvement. Early recognition and multidisciplinary management are essential to prevent long-term morbidity.