obsolete peripheral enthesopathy

Peripheral Enthesopathy: An Overview

Peripheral enthesopathy refers to a condition characterized by inflammation and degeneration at the sites where tendons, ligaments, or fascia attach to bones (entheses) [2][5]. This condition can lead to pain, stiffness, and limited mobility in affected joints.

Causes and Risk Factors

The exact causes of peripheral enthesopathy are not well understood. However, it is believed to be associated with chronic inflammation at the enthesis sites [7]. Other risk factors may include:

• Genetic predisposition: Some individuals may be more prone to developing peripheral enthesopathy due to their genetic makeup.
• Age: The condition tends to affect middle-aged and older adults.
• Sex: Women are more likely to develop peripheral enthesopathy than men.

Symptoms

The symptoms of peripheral enthesopathy can vary depending on the affected joint. Common complaints include:

• Pain: Aching or sharp pain in the affected joint, which may worsen with activity.
• Stiffness: Limited mobility and stiffness in the affected joint, especially after periods of rest.
• Swelling: Inflammation and swelling at the enthesis site.

Treatment Options

While there is no cure for peripheral enthesopathy, various treatment options can help manage symptoms and improve quality of life. These may include:

• Medications: Anti-inflammatory medications, pain relievers, and corticosteroids to reduce inflammation and alleviate pain.
• Physical therapy: Gentle exercises and stretches to maintain joint mobility and strengthen surrounding muscles.
• Lifestyle changes: Maintaining a healthy weight, quitting smoking, and engaging in regular physical activity can help manage symptoms.

Complications

If left untreated or poorly managed, peripheral enthesopathy can lead to complications such as:

• Tendon injuries: Chronic inflammation can cause tendon damage and rupture.
• Bone erosions: Repeated inflammation can lead to bone erosion and structural damage.

It is essential to consult a healthcare professional for an accurate diagnosis and personalized treatment plan.

Based on the provided context, here are the signs and symptoms of obsolete peripheral enthesopathy:

• Pain at specific locations near joints: The pain can feel like generalized joint pain or be localized to a specific area near the joint. For example, a person with enthesopathy in the Achilles tendon may experience worsening pain when running or walking [3].
• Tenderness and swelling: The affected areas may be tender to touch and swollen, which can reduce range of motion [8].
• Nail changes: Some patients may experience nail changes such as cracking or other abnormalities [4].
• Episodic flares with periods of remission: In some cases, symptoms may come and go in episodes (flares) with periods of remission in between [4].

It's worth noting that the prognosis and treatment for enthesopathy can vary depending on the specific condition and its cause. A thorough physical examination is essential for identifying the signs and symptoms of enthesopathy.

References: [3] - The symptoms of enthesitis and enthesopathy are the same and can feel like generalized joint pain, or pain at a specific location near the joint. [4] - Other signs and symptoms. Nail changes: Changes in the fingernails or toenails, such as nail cracking, ... Some patients experience episodic flares with periods of remission, while others may have persistent symptoms. [8] - A thorough physical examination is essential for identifying the signs and symptoms of enthesopathy. The healthcare provider will assess the affected areas for tenderness, swelling, and reduced range of motion.

Based on the provided context, it appears that there are various diagnostic tests used to diagnose peripheral enthesopathy, which includes enthesitis as one of its types.

Imaging Examinations

• Imaging examinations such as X-rays, ultrasound, and MRI (magnetic resonance imaging) can be used to take pictures of the body and look for injuries or inflammation in the entheses region [10].
• Power Doppler ultrasound is a reliable tool that can identify enthesitis in patients with SpA [2].
• Contrast-enhanced MRI can also identify relatively more sites of enthesitis at lumbar vertebra and pelvis, although its accuracy may vary [3].

Laboratory Tests

• Blood tests such as anticitrullinated protein antibodies (ACPA), rheumatoid factor (RF), and HLA-B27 can be used to support the diagnosis of SpA and other inflammatory conditions [6].
• However, these laboratory tests are not specific for enthesitis and may have limited diagnostic value.

Clinical Examination

• The clinical examination is a crucial part of diagnosing enthesitis, which involves applying pressure to the entheses region to reveal pain and/or discomfort in these regions [8].
• A physical exam can also be used to check for swelling and tenderness in the affected area [12].

It's worth noting that the diagnosis of enthesitis is often based on rather non-specific clinical signs and results of laboratory tests, which may limit its accuracy [13][15]. Imaging examinations may improve diagnosis, particularly in differentiating enthesitis from other enthesopathic processes [15].

References: [2] - by X Wu · 2022 · Cited by 8 [3] - by X Wu · 2022 · Cited by 8 [6] - Dec 22, 2017 [8] - by S Sener · 2024 · Cited by 3 [10] - [12] - [13] - [15] -

Treatment Options for Obsolete Peripheral Enthesopathy

Obsolete peripheral enthesopathy, also known as enthesitis, refers to inflammation and pain in the tendons and ligaments that connect joints to bones. While there are various treatment options available, the most effective approach often depends on the underlying cause of the condition.

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help alleviate pain and reduce inflammation in the affected area [12]. However, their use is somewhat controversial in the acute period, as they may inhibit healing by blunting the inflammatory response.
• Biologics: In some cases, biologic medications like ustekinumab (Stelara) or apremilast (Otezla) may be prescribed to treat enthesitis associated with conditions such as psoriatic arthritis [6][13].
• Physical Therapy and Lifestyle Changes: Engaging in physical therapy, modifying daily activities, and making lifestyle changes can help manage symptoms and prevent further injury.
• Surgical Procedures: In severe cases or when other treatments fail, surgical procedures may be necessary to address the underlying cause of enthesitis.

Important Considerations

When treating obsolete peripheral enthesopathy, it's essential to consider the following factors:

• Duration of Symptoms: If peripheral arthritis is present, it should persist for at least 6 weeks [14].
• Underlying Cause: Treatment depends on the underlying etiology of the condition.
• Risk of Infection: Certain medications or treatments may increase the risk of infection.

References

[12] Controversy surrounding NSAID use in acute enthesopathy treatment [13] Ultrasonographic improvement of peripheral subclinical enthesopathy in therapy-naive patients treated with ustekinumab for chronic plaque psoriasis: a 52-week, prospective, open label, controlled cohort study. [14] Criteria for diagnosing peripheral arthritis and sacroiliitis.

The differential diagnosis of obsolete peripheral enthesopathy involves