Features of #enthesitis #synovitis

ASSR COW #15

ANSWER: Intramedullary Sarcoid with Enthesitis

Psoriatic arthritis or Erosive Inflammatory OA?
Can be very tricky Hx & Ex impt but sometimes still unclear!
#PsA = ‘Mouse Ear’ sign & marginal erosions.
Enthesitis, Dactylitis
#OA = Erosions central ‘Gull Wing’ w/outer lip of reactive bone (Serology N)
Doesn’t respond to Rx!

1st case series of post #COVID #ReA of 23 patients with review published!
🦴 Lower limb predominant, asymmetrical, oligoarticular involvrment common
🦴 Enthesitis and axial pain✔️
🦴 Avg. no. of joints involved-3️⃣
🦴 Treatment responsive with no relapses authors.elsevier.com/c/1f3TT,celmGY…

🛑Schematic of Achilles tendon enthesitis.👍A thickened Achilles tendon /with ⬆️ vascularity. Enthesophyte &calcific intratendinous changes. Fibrocartilaginous junction depicted as blue line (arrowhead).
Distension of retrocalcaneal bursa(B) shown adjacent to calcaneal erosion(E)

#Dactylitis is a type of #Enthesitis

⚠️ps. Don’t forget #TB as a cause (easily missed!)

#PsA #sarcoidosis #gout #SickleCellDisease #Psoriasis

Distal iliotibial band enthesitis - A 55-year-old woman presents with a painful swelling on the anterolateral side, raising clinical suspicion of external meniscopathy. #Orthopedics #Enthesitis

Synovitis=inflammation of synovial membrane.
Enthesitis=inflammation of entheses(insertion sites of tendons&ligaments to bone surface) nature.com/articles/nrrhe…
Enthesitis is periarticular butalso occur at the sites distant from joints(red circles)👉at Achilles tendon,plantarfascia

1 in 3 people with psoriatic arthritis(PsA) will develop ENTHESITIS.While this painful problem can affect anyone,but it's more common among people with PsA & other forms of axial spondyloarthritis. Visualization of Enthesitis by U/S:a Key Diagnostic Tool..
link.springer.com/article/10.100…

#EULAR2022
Rheumatology across boundaries
The eye in rheumatic diseases
🧿The Pathophysiology of Uveitis is poorly understood
🧿 Uveitis is thought to be due to enthesitis of ciliary body attachment
🧿TH17 and TH1 are major mediators of inflammation

🔥🆕The 2022 BSR guideline for the Rx of PsA with bDMARDs and tsDMARDs
When b/tsDMARDs indicated
💉pArthritis: TNFi/ IL17i/ upadacitinib (UPA)>IL12/23i or IL23i>PDE4i>CTLA4-Ig
💉Axial: TNFi/ IL17i/JAKi
💉Enthesitis/Dactylitis: Any
doi.org/10.1093/rheuma…
doi.org/10.1093/rheuma…

🔺Synovio-Entheseal Complex and Resultant Features of #SpA .

#enthesitis #synovitis #tenosynovitis #erosion #sacroilitis #spondylitis #BMO #osteitis #tendonitis #periostitis #AxSpA

#bDMARD treatment for #Enthesitis

Meta-analysis: All very similar outcomes with no significant difference in efficacy of all the biologic therapies

Confidence intervals all overlapping so impossible to say one drug class is superior to the other!

#Rheumatology #MedTwitter

#AxSpA 🆚 #PsA

Different mechanisms in axial involvement in AxSpA and PsA

#psoriaticArthritis #HLAb27 #uveitis #dactylitis #enthesitis #inflammation #arthritis

go.nature.com/4847GIb

A classic image of inflammatory enthesitis in a patient with Psoriatic Arthritis, with a rare but very specific finding: erosion with positive power doppler #PsA #psoriaticarthritis #Spondyloarthritis #MSKUS

It can be hard to distinguish ENTHESITIS from DACTYLITIS in our minds:
Enthesitis (Top): tender and ligament insertion points. pain with tenderness at these connections

Dactylitis (Bottom): Entire digit swollen

وافقت (FDA) على  secukinumab لعلاج enthesitis-related arthritis (ERA)
لدى الأطفال والمراهقين بعمر 4 سنوات فما فوق. كما قامت (FDA) بتمديده لعلاج  psoriatic arthritis (PsA) ليشمل الأطفال من عمر سنتين فما فوق وهو العلاج البيولوجي الأول المعتمد للأطفال لكل من ERA و PsA في USA .

Targeting the HUGE dilemma!🎯

#Psoriatic vs Erosive #OA

PsA
👉 Fluffy bone formation(enthesitis of phalanges)
👉 Marginal erosions(vs central)
👉 Many jts in same digit(ray inv)
👉 Periarticular SOFT tissue swelling (dactylitis).
👉 NOT much hand OA

#ACR21 RadiologyBootCamp

Enthesis is the insertion of a tendon, ligament, capsule or fascia into bone.
#POCUS Here are 4 examples of #Enthesitis 🔥in 4 different sites of R knee compared with L knee -same patient- Based👉OMERACT definition(2019)
#MSKUS #MSUS
Dr. Mendoza Torres
Michael Pelea
Juan Molina Collada

#ASAS publication

In case you missed it: An ancillary analysis of the ASAS Per-SpA study examined the problematic overlap between fibromyalgia and enthesitis between males and females with axSpA

Full article here: sciencedirect.com/science/articl…