Entezopatie i zapalenie entez. Część II. Diagnostyka obrazowa

• Authors: Iwona Sudoł-Szopińska , Brygida Kwiatkowska , Monika Prochorec-Sobieszek , Grzegorz Pracoń , Marta Walentowska-Janowicz , Włodzimierz Maśliński

Title variants

EN

Enthesopathies and enthesitis. Part 2: Imaging studies

• Languages of publication: EN PL

Abstracts

EN

The pathologies of tendon and ligament attachments are called enthesopathies. Enthesitis is one of enthesopathies and it is considered a characteristic sign of rheumatic diseases from the spondyloarthritis group, including peripheral spondyloarthritis. Therefore, enthesitis has been included in a number of clinical classifications for diagnosing these diseases. Clinical diagnosis of enthesitis is based on rather non-specific clinical signs and results of laboratory tests. It is believed that imaging examinations might improve diagnosis, particularly because numerous papers prove that differentiating enthesitis from other enthesopathic processes is possible. On the other hand, a number of authors report the lack of specific signs in imaging as well as typical histological and immunological features that would enable confirmation of clinical diagnosis of enthesitis. The first part of the publication presented theories on the etiopathogenesis of enthesitis (inflammatory, mechanical, autoimmune and associated with the synovio-entheseal complex) as well as on the formation of enthesophytes (inflammatory, molecular and mechanical). This paper – the second part of the article, is a review of the state-of-the-art on the ability of imaging examinations to diagnose enthesitis. It turns out that none of the enthesitis criteria used in imaging examinations is specific for inflammation. As enthesitis may be the only symptom of early spondyloarthritis (particularly in patients with absent HLA-B27 antigen), the lack of its unambiguous picture in ultrasound and magnetic resonance imaging prompts the search for other signs characteristic of spondyloarthritis and more specific features in imaging in order to make a diagnosis as early as possible.

PL

Patologie przyczepów ścięgien i więzadeł są określane mianem entezopatii. Jednym z rodzajów entezopatii jest zapalenie (enthesitis). Uznaje się je za charakterystyczny objaw chorób reumatycznych z grupy spondyloartropatii (spondyloarthritis), w tym głównie spondyloartropatii obwodowych. Z tego powodu enthesitis włączono do szeregu klasyfikacji klinicznych, służących m.in. do rozpoznawania tych chorób. Klinicyści diagnozują enthesitis na podstawie mało specyficznych objawów oraz wyników badań laboratoryjnych. Duże nadzieje na poprawę możliwości diagnostycznych są wiązane z badaniami obrazowymi. Niektóre prace naukowe dowodzą możliwości różnicowania zapalenia entez z innymi procesami entezopatycznymi. Z drugiej strony szereg doniesień wskazuje na brak specyficznych zmian w badaniach obrazowych oraz typowych cech histologicznych i immunologicznych pozwalających na potwierdzenie klinicznego rozpoznania enthesitis. W pierwszej części publikacji przedstawiono teorie etiopatogenezy entezopatii (teorię zapalną, mechaniczną, kompleksu entezy i autoimmunologiczną) oraz koncepcje powstawania entezofitów (zapalną, molekularną i mechaniczną). W niniejszej, drugiej części zaprezentowano zaś przegląd wiedzy na temat możliwości badań obrazowych w rozpoznawaniu enthesitis. Jak się okazuje, żadne z kryteriów enthesitis stosowanych w badaniach obrazowych nie jest specyficzne dla zapalenia. Zważywszy na to, że enthesitis bywa jedynym objawem spondyloartropatii w początkowym okresie (zwłaszcza u chorych z nieobecnym antygenem HLA-B27), brak jednoznacznego obrazu w badaniach ultrasonograficznych i rezonansu magnetycznego wymaga poszukiwania innych objawów charakterystycznych dla spondyloartropatii i bardziej specyficznych markerów w badaniach obrazowych w celu jak najszybszego ustalenia rozpoznania.

Keywords

EN

badania obrazowe; choroby reumatyczne; entezopatie; enthesitis; enthesopathy; imaging; rheumatic diseases; spondyloarthritis; spondyloartropatie

Discipline

• MEDICINE: MEDICINE

• Journal: Journal of Ultrasonography
• Year: 2015
• Volume: 15
• Issue: 61
• Pages: 196–207

Contributors

author

Iwona Sudoł-Szopińska

• Department of Radiology, Institute of Rheumatology, Spartańska 1, 02-637 Warsaw, Poland, tel./fax: [phone]. Department of Diagnostic Imaging, Second Faculty, Warsaw Medical University, Poland,

author

Brygida Kwiatkowska

• Early Arthritis Clinic, Institute of Rheumatology, Warsaw, Poland

author

Monika Prochorec-Sobieszek

• Department of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland. Department of Pathophysiology, Immunology, and Pathological Anatomy, Institute of Rheumatology, Warsaw, Poland

author

Grzegorz Pracoń

• Department of Radiology, Institute of Rheumatology, Warsaw, Poland

author

Marta Walentowska-Janowicz

• Department of Radiology, Institute of Rheumatology, Warsaw, Poland

author

Włodzimierz Maśliński

• Department of Pathophysiology, Immunology, and Pathological Anatomy, Institute of Rheumatology, Warsaw, Poland

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• Document Type: review