Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
, 13 (12), 731-741

Enthesitis: From Pathophysiology to Treatment

Affiliations
Review

Enthesitis: From Pathophysiology to Treatment

Georg Schett et al. Nat Rev Rheumatol.

Abstract

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 initiation phase of enthesitis, as well as the role of entheseal IL-23-responsive cells that augment inflammation by producing pro-inflammatory mediators such as IL-17A, IL-22 and TNF. In addition, the molecular steps that translate inflammation into resident tissue responses, resulting in new bone formation, are discussed. The second part of the article summarizes the clinical features of enthesitis, and the role of clinical and imaging instruments in detecting enthesitis are discussed together with their challenges and limitations. Finally, the Review summarizes the current treatment possibilities for enthesitis based on the aforementioned pathophysiological concepts, focusing on the role of cytokine-blocking agents.

Similar articles

  • Advances in the Understanding of Entheseal Inflammation
    D McGonagle et al. Curr Rheumatol Rep 4 (6), 500-6. PMID 12427365. - Review
    The importance of enthesitis in the pathogenesis of spondyloarthropathy (SpA) is now well recognized. Several entheses comprise more than simply the insertion site, and t …
  • MRI of Enthesitis of the Appendicular Skeleton in Spondyloarthritis
    I Eshed et al. Ann Rheum Dis 66 (12), 1553-9. PMID 17526551. - Review
    Entheses are sites where tendons, ligaments, joint capsules or fascia attach to bone. Inflammation of the entheses (enthesitis) is a well-known hallmark of spondyloarthri …
  • Enthesitis
    MA D'Agostino et al. Best Pract Res Clin Rheumatol 20 (3), 473-86. PMID 16777577. - Review
    Enthesitis is a distinctive pathological feature of spondyloarthritis and may involve synovial joints, cartilaginous joints, syndesmoses and extra-articular entheses. Thi …
  • Psoriatic Enthesitis: An Update From the GRAPPA 2013 Annual Meeting
    CT Ritchlin. J Rheumatol 41 (6), 1220-3. PMID 24882856.
    The enthesis, attachment site of ligaments, tendons, and joint capsules to bone, has emerged as a complex structure or entheseal organ that dissipates stress to maintain …
  • The Enthesis in Psoriatic Arthritis
    D McGonagle et al. Clin Exp Rheumatol 33 (5 Suppl 93), S36-9. PMID 26472070. - Review
    In recent years the argument that enthesitis is the primary lesion in many or most patients with psoriatic arthritis and spondyloarthritis has gained further credence fro …
See all similar articles

Cited by 24 PubMed Central articles

See all "Cited by" articles

References

    1. BMJ. 2010 Feb 02;340:c147 - PubMed
    1. J Immunol. 2011 Jul 15;187(2):951-9 - PubMed
    1. J Rheumatol. 2012 Apr;39(4):677-8 - PubMed
    1. J Bone Miner Res. 2003 Sep;18(9):1584-92 - PubMed
    1. Ann Rheum Dis. 2002 Oct;61(10 ):905-10 - PubMed

MeSH terms

Substances

Feedback