Is Bony Evidence of Enthesial Reaction Sufficient for Differential Diagnosis?

Journal Title: Journal of Musculoskeletal Disorders and Treatment - Year 2017, Vol 3, Issue 2

Abstract

Background Enthesial reaction, as a stress or disease marker, has been a generalized perspective, largely untested as to its veracity. Perhaps valid with soft tissue visualization by computerized tomography or magnetic resonance imaging, examination of standard radiographs reveals minimal evidence of enthesial reaction. The current study seeks to assess the disease-specificity of enthesial reaction by examining the primary evidence that of disease-related variation in its presence in defleshed skeletons. Methods Defleshed skeletons were evaluated macroscopically (in a manner blinded according to disease diagnosis) to assess presence of enthesial reaction. The skeletal sample included individuals diagnosed on the basis of clinical and previously validated non-enthesial reaction-based criteria as having spondyloarthropathy, calcium pyrophosphate deposition disease (CPPD) and diffuse idiopathic skeletal hyperostosis. These diseases are classically considered predisposed to enthesial reaction. They were contrasted with those which are not (rheumatoid arthritis and healthy individuals). The latter cohort was developed by excluding individuals with diseases that could have an enthesial component (e.g., renal disease, hypertrophic osteoarthropathy). Sixty-six macroscopically examined sites were assessed (ANOVA) individually and also according to established scoring systems. Results Prevalence of enthesial reaction at individual sites was indistinguishable, with notable exception of posterior iliac spine, ischial tuberosity and lateral elbow largely spared in healthy individuals, greater trochanter was more commonly affected in spondyloarthropathy and CPPD and distal lateral femoral sparing occurred in rheumatoid arthritis. Limited scoring systems performed poorly. Conclusions Macroscopic bone manifestation of enthesitis has insufficient prevalence variation among diseases to be useful in distinguish among them. Absence of macroscopic evidence of significant enthesial reaction explains the inadequacy of plain radiographs in its recognition. Enthesitis appears to be predominantly a soft tissue phenomenon, analogous to dactylitis.

Authors and Affiliations

Keywords

Related Articles

Acute Lymphoblastic Leukemia in Systemic Lupus Erythematosus Disguise: A Case Report

The present report describes the case of an 18-year-old male exhibiting Acute Lymphocytic Leukemia (ALL). He initially presented with a multitude of rheumatic manifestations that were attributed to Systemic Lupus Erythem...

Regenerative Therapy in Osteoarthritis of the Knee

Osteoarthritis (OA) is the most common joint disorder in the world. It commonly affects the knee and current treatment options are limited, focusing mainly on symptom relief. It is now known that OA is the result of both...

Perspectives on Improving the Efficacy of PRP Treatment for Tendinopathy

Platelet-rich plasma (PRP), popularly called PRP, is almost like a "house-hold" name these days because of its wide recognition by physicians and patients due to its prevalent use. The popularity of PRP is due to its eff...

Diaphyseal Femur Fractures in Children: A Preliminary Study Comparing the use of Elastic Stable Intramedullary Nailing (ESIN) Versus Locking Compression Plates (LCP)

Objective: To compare the functional and radiological results of diaphyseal femur fractures in children between the use of ESIN (Elastic Stable Intramedullary Nail) versus LCP (Locking Compression Plates). Material and...

Deep Venous Thrombosis in Behcet's Syndrome: is Anticoagulation Necessary?

Deep vein thrombosis (DVT) in the lower extremities is a common medical presentation. Anticoagulation is the cornerstone of management. However, not all DVTs require anticoagulation. We report a case of DVT in a patient...

Download PDF file
  • EP ID EP348098
  • DOI 10.23937/2572-3243.1510032
  • Views 114
  • Downloads 0

How To Cite

(2017). Is Bony Evidence of Enthesial Reaction Sufficient for Differential Diagnosis?. Journal of Musculoskeletal Disorders and Treatment, 3(2), 1-6. https://europub.co.uk/articles/-A-348098