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Continuing Medical Education

CME-Sonografie 93: Ultraschall der Enthese – nicht jede «Enthesitis» bedeutet eine Spondyloarthritis

Published Online:September 01, 2020https://doi.org/10.1024/1661-8157/a003566

Abstract

Zusammenfassung. In diesem CME konzentrieren wir uns auf die Ultraschallanatomie der Enthese. Im Weiteren beschreiben wir Enthesopathien und Enthesitiden und diskutieren damit verbundene differenzialdiagnostische Überlegungen. Es ist wichtig, sämtliche Erkrankungen zu kennen, welche sich an der Enthese manifestieren können, damit Diagnosen korrekt gestellt werden können. Dabei kann der Ultraschall die Differenzialdiagnose massgebend eingrenzen. An dieser Stelle sei erwähnt, dass der Befund einer Enthesitis nicht zwingend mit einer Spondylarthritis assoziiert sein muss.


CME Sonography 93: Ultrasound of the Enthesis – Not Every “Enthesitis” Signals a Spondyloarthritis

Abstract. In this CME we will focus on the ultrasound anatomy of the enthesis. In addition, we describe the terms enthesopathy and enthesitis and discuss related differential diagnostic considerations. It is important to know all the diseases that can manifest themselves at the enthesis, so that diagnoses can be made, and patients classified correctly. At this point it is worth mentioning that the findings of enthesitis do not necessarily need to be associated with spondylarthritis.

Literaturempfehlungen

  • Abate M, Salini V, Antinolfi P, Schiavone C. Ultrasound morphology of the Achilles in asymptomatic patients with and without diabetes. Foot Ankle Int. 2014;35(1):44–49. doi:10.1177/ 1071100713510496. First citation in articleCrossref Medline, Google Scholar

  • Aydin SZ, Bas E, Basci O, et al.. Validation of ultrasound imaging for Achilles entheseal fibrocartilage in bovines and description of changes in humans with spondyloarthritis. Ann Rheum Dis. 2010;69(12):2165–2168. First citation in articleCrossref Medline, Google Scholar

  • Bakirci S, Solmaz D, Stephenson W, Eder L, Roth J, Aydin SZ. Entheseal changes in response to age, body mass index, and physical activity: An ultrasound study in healthy people. J Rheumatol. 2020;47(7):968–972. doi:10.3899/jrheum.190540 doi:10.1136/ard.2009.127175. First citation in articleCrossref Medline, Google Scholar

  • Balint PV, Terslev L, Aegerter P, et al.. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis. 2018;77(12):1730–1735. doi:10.1136/annrheumdis-2018-213609. First citation in articleCrossref Medline, Google Scholar

  • Benjamin M, Moriggl B, Brenner E, Emery P, McGonagle D, Redman S. The “enthesis organ” concept: why enthesopathies may not present as focal insertional disorders. Arthritis Rheum. 2004;50(10):3306–3313. doi:10.1002/art.20566. First citation in articleCrossref Medline, Google Scholar

  • Bruyn G, HÁnovÁ P, Faith N. Enthesitis: myth or reality? J Rheumatol. 2020;47(7):945–946. doi:10.3899/jrheum.200114. First citation in articleCrossref Medline, Google Scholar

  • D’Agostino MA, Aegerter P, Bechara K, et al.. How to diagnose spondyloarthritis early? Accuracy of peripheral enthesitis detection by power Doppler ultrasonography. Ann Rheum Dis. 2011;70(8):1433–1440. doi:10.1136/ard.2010.138701. First citation in articleCrossref Medline, Google Scholar

  • de Miguel E, Muñoz-Fernández S, Castillo C, Cobo-Ibáñez T, Martín-Mola E. Diagnostic accuracy of enthesis ultrasound in the diagnosis of early spondyloarthritis. Ann Rheum Dis. 2011;70(3):434–439. doi:10.1136/ard.2010.134965. First citation in articleCrossref Medline, Google Scholar

  • Filippucci E, Aydin SZ, Karadag O, et al.. Reliability of high-resolution ultrasonography in the assessment of Achilles tendon enthesopathy in seronegative spondyloarthropathies. Ann Rheum Dis. 2009;68(12):1850–1855. doi:10.1136/ard.2008.096511. First citation in articleCrossref Medline, Google Scholar

  • Gandjbakhch F, Terslev L, Joshua F, et al.. Ultrasound in the evaluation of enthesitis: status and perspectives. Arthritis Res Ther. 2011;13(6):R188. doi:10.1186/ar3516 First citation in articleCrossref Medline, Google Scholar

  • Mandl P, Navarro-Compán V, Terslev L, et al.. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis. 2015;74(7):1327–1339. doi:10.1136/annrheumdis-2014-206 971. First citation in articleCrossref Medline, Google Scholar

  • Naredo E, Batlle-Gualda E, García-Vivar ML, et al.. Power Doppler ultrasonography assessment of entheses in spondyloarthropathies: response to therapy of entheseal abnormalities. J Rheumatol. 2010;37(10):2110–2117. doi:10.3899/jrheum. 100136 First citation in articleCrossref Medline, Google Scholar

  • McGonagle D, Wakefield RJ, Tan AL, et al.. Distinct topography of erosion and new bone formation in achilles tendon enthesitis: implications for understanding the link between inflammation and bone formation in spondylarthritis. Arthritis Rheum. 2008;58(9):2694–2699. doi:10.1002/art.23755. First citation in articleCrossref Medline, Google Scholar

  • Michelsen B, Diamantopoulos AP, Soldal DM, Hammer HB, Kavanaugh A, Haugeberg G. Achilles enthesitis defined by ultrasound is not associated with clinical enthesitis in patients with psoriatic arthritis. RMD Open. 2017;3(2):e000486. Published 2017 Aug 16. doi:10.1136/rmdopen-2017-000486. First citation in articleCrossref Medline, Google Scholar

  • Tom S, Zhong Y, Cook R, Aydin SZ, Kaeley G, Eder L. Development of a preliminary ultrasonographic enthesitis score in psoriatic arthrtitis – GRAPPA Ultrasound Working Group. J Reumatol. 2019; 46: 384–390. First citation in articleMedline, Google Scholar

  • Ozkan F, Cetin GY, Bakan B, et al.. Sonographic evaluation of subclinical entheseal involvement in patients with Behçet disease. AJR Am J Roentgenol. 2012;199(6):W723-W729. doi:10. 2214/AJR.12.8576. First citation in articleCrossref Medline, Google Scholar