Ultrasound features of shoulder involvement in patients with ankylosing spondylitis: a case–control study
Based on a series of 37 personal patients and data from the literature, a number of characteristics of enthesopathies can be observed in the course of inflammatory spondyloarthropathies. Our series is based on 20 cases of ankylosing spondylitis (ASP), 8 cases of Fiessinger-Leroy-Reiter syndrome, 8 cases of psoriatic rheumatism (Pso Rh) and one combined form (psoriasis + Reiter + ASP). As well as the frequent involvement of the calcaneus (29 patients), we found more unusual extra-calcaneal localisations in 23 patients. The clinical symptomatology consisted of pain on activity and on weight-bearing at the sites of insertion of the tendons, which were sometimes swollen. The disease was occasionally very incapacitating. The radiological signs consist of lesions of erosion (initially) and reconstruction (subsequently). The histological signs consist of zones of osseous reorganisation and osteo-tendinous inflammatory infiltration. The mechanism of these enthesopathic lesions is still unclear. Our observations are similar to those reported in the literature, which are essentially paediatric studies. Enthesopathy appears to be a diagnostic and lesional element in common with inflammatory spondyloarthropathies (which include ASP, Reiter's Pso Rh, enteropathic rheumatisms and Behçet's disease) and, at least partially, with juvenile rheumatisms. In the latter case, the precocity of the tendinoperiosteal signs seems to be a very important element in the orientation of the diagnosis at the pre-spondylitic stage.