Enthesitis: from pathophysiology to treatment

@article{Schett2017EnthesitisFP,
  title={Enthesitis: from pathophysiology to treatment},
  author={Georg Schett and Rik Lories and Maria Antonietta D’Agostino and Dirk Elewaut and Bruce W. Kirkham and Enrique Roberto Soriano and D. Mcgonagle},
  journal={Nature Reviews Rheumatology},
  year={2017},
  volume={13},
  pages={731-741}
}
Entheses are the insertion sites of tendons and ligaments to the bone surface and are essential structures for locomotion. Inflammation of the entheses (enthesitis) is a key feature of psoriatic arthritis and spondyloarthritis. To date, our conceptual understanding of enthesitis remains limited. This Review provides an insight into the pathophysiology of enthesitis, addressing the role of biomechanics, prostaglandin E2-mediated vasodilation and the activation of innate immune cells in the… Expand
Enthesitis, a clinical manifestation with many unknowns
TLDR
The advances in the knowledge of some molecular, pathophysiological and therapeutic characteristics of this clinical manifestation are insufficient and still do not allow to impact totally on the deterioration of the quality of life that it generates. Expand
Clinical significance of spondyloarthritis-attended enthesites: from pathophysiology to treatment (review)
TLDR
The article presents the latest views on enthesites’ anatomy and pathogenesis, clinical features, diag­ nostic and thera peutic options for spondyloarthritis patients. Expand
Research Progress in Pathophysiological Mechanism of Enthesitis in Spondyloarthritis
Objective: The entheses is one of the main targets of the bone inflammation in the disease such as Spondyloarthritis (SpA). In the past, the incidence of enthesitis in SpA has been underestimated. InExpand
Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances
TLDR
The MRI whole-body score for inflammation in peripheral joints and entheses (MRI-WIPE) is a promising scoring system, which is undergoing further testing in clinical trials and longitudinal cohorts evaluating global measures of inflammation at entheses. Expand
Enthesitis in psoriatic arthritis (Part 1): pathophysiology
TLDR
Current knowledge on the mechanisms involved in the development of enthesitis in patients with PsA, including activation of pro-inflammatory mediators such as IL-17 and TNF-α as well as the influx of innate immune cells, are reviewed. Expand
The management of enthesitis in clinical practice.
TLDR
Emerging data suggest interleukin-17 and 12/23 inhibitors may be the first choice in PsA patients with enthesitis, and preliminary data suggest that targeting IL-17 or IL12/23 may be more efficacious for controllingEnthesitis than TNF inhibition. Expand
The Role of Ultrasound in Psoriatic Arthritis — Do We Need a Score?
TLDR
US has been proven to be a valuable tool to assess entheseal involvement across the SpA spectrum, including PsA7,8,9 … Address correspondence to L.C. Coates, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK. Expand
Role of the IL-23 pathway in the pathogenesis and treatment of enthesitis in psoriatic arthritis
TLDR
Although it is currently unable to identify the best therapeutic window to target IL-23 in SpA disease evolution, the promising ability of this therapy to control the gut-entheseal axis is increasing the authors' knowledge of SpA pathogenesis. Expand
A model of chronic enthesitis and new bone formation characterized by multimodal imaging
TLDR
A new and reliable enthesitis model triggered by innate immune cells is introduced and multimodal imaging is established for dynamically assessing inflammation, tissue perfusion and bone remodelling in vivo to help to disentangle the molecular pathways involved in the effector phase ofEnthesitis. Expand
Recent Updates in the Immunopathology of Type 3 Immunity-Mediated Enthesitis
TLDR
Immune cells demonstrating distinct features orchestrate entheses, leading to the complex landscape of enthesitis, however, recent advances in understanding the immunopathogenesis may provide new therapeutic targets and future research directions. Expand
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 113 REFERENCES
Proof of concept: enthesitis and new bone formation in spondyloarthritis are driven by mechanical strain and stromal cells
TLDR
Findings provide a formal proof of the concept that mechanical strain drives both entheseal inflammation and new bone formation in SpA. Expand
The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites
TLDR
It is proposed that the inflammatory responses characteristic of spondyloarthropathies are triggered at these seemingly diverse sites, in genetically susceptible individuals, by a combination of anatomical factors which lead to higher levels of tissue microtrauma, and the deposition of microbes. Expand
Histological assessment of the early enthesitis lesion in spondyloarthropathy
TLDR
The enthesis architecture was abnormal in the SpA group, with increased vascularity and cellular infiltration compared with normal subjects, and these preliminary findings have implications for a better understanding of the pathology in early SpA. Expand
The "enthesis organ" concept: why enthesopathies may not present as focal insertional disorders.
TLDR
The concept of an enthesis organ is of general significance in understanding attachment sites and may explain the diverse pathologic changes, including synovitis, bursitis, and extracapsular changes, seen adjacent to tendon/ligament entheses in SpA. Expand
Classification of inflammatory arthritis by enthesitis
TLDR
It is proposed that the synovitis of spondyloarthropathy is secondary to liberation of proinflammatory mediators from the enthesis, whereas the synvitis of rheumatoid arthritis is primary. Expand
Assessment of enthesitis in ankylosing spondylitis
TLDR
Reduction of the number of entheses from 66 to 13 and omitting grading of the intensity of pain resulted in an index which was named the “Maastricht Ankylosing Spondylitis Enthesitis Score” (MASES), which seems to be a good alternative to the MEI with much better feasibility. Expand
Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis.
TLDR
The enthesis index (EI) is a convenient, non-invasive measure of disease severity in patients with AS and potential applications include the assessment of enthesitis in other polyarthritides and a means of distinguishing clinically between severity ofEnthesitis and synovitis in different types of polyarthritis. Expand
Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy
TLDR
US is better than clinical examination in the detection of entheseal abnormality of the lower limb in patients with spondyloarthropathy, and a quantitative US score of lower limb enthesitis is proposed but further studies are required to validate it in SpA. Expand
IL-23 induces spondyloarthropathy by acting on ROR-γt+ CD3+CD4−CD8− entheseal resident T cells
The spondyloarthropathies are a group of rheumatic diseases that are associated with inflammation at anatomically distal sites, particularly the tendon-bone attachments (entheses) and the aorticExpand
Ultrasound in the evaluation of enthesitis: status and perspectives
TLDR
Ultrasound has evidence to support face, content validity and reliability for the evaluation of enthesitis, though there is a lack of well-reported methodology in most of the studies. Expand
...
1
2
3
4
5
...