MRI of Enthesitis of the Appendicular Skeleton in Spondyloarthritis

Overview

Journal Ann Rheum Dis

Specialty Rheumatology

Date 2007 May 29

PMID 17526551

Citations 64

Authors

Iris Eshed

Matthias Bollow

Dennis G McGonagle

Ai Lyn Tan

Christian E Althoff

Patrick Asbach

Kay-Geert A Hermann

Affiliations

Soon will be listed here.

Abstract

Entheses are sites where tendons, ligaments, joint capsules or fascia attach to bone. Inflammation of the entheses (enthesitis) is a well-known hallmark of spondyloarthritis (SpA). As entheses are associated with adjacent, functionally related structures, the concepts of an enthesis organ and functional entheses have been proposed. This is important in interpreting imaging findings in entheseal-related diseases. Conventional radiographs and CT are able to depict the chronic changes associated with enthesitis but are of very limited use in early disease. In contrast, MRI is sensitive for detecting early signs of enthesitis and can evaluate both soft-tissue changes and intraosseous abnormalities of active enthesitis. It is therefore useful for the early diagnosis of enthesitis-related arthropathies and monitoring therapy. Current knowledge and typical MRI features of the most commonly involved entheses of the appendicular skeleton in patients with SpA are reviewed. The MRI appearances of inflammatory and degenerative enthesopathy are described. New options for imaging enthesitis, including whole-body MRI and high-resolution microscopy MRI, are briefly discussed.

Citing Articles

Radiographic entheseal lesions of the pelvic region are more prevalent in radiographic axSpA than in age- and sex-matched controls and are associated with more severe spinal disease.

Wink F, Diemel T, Arends S, Spoorenberg A Clin Rheumatol. 2025; 44(3):1141-1150.

PMID: 39885099 PMC: 11865150. DOI: 10.1007/s10067-025-07345-8.

Non-invasive evaluation of Achilles tendon and its enthesis using ultrashort echo time adiabatic T (UTE-Adiab-T) magnetic resonance imaging (MRI) in psoriatic arthritis.

Moazamian D, Shaterian Mohammadi H, Athertya J, Daskareh M, Ma Y, Guma M Eur J Radiol. 2024; 183:111841.

PMID: 39667119 PMC: 11844800. DOI: 10.1016/j.ejrad.2024.111841.

Clinical implications of reconsideration of enthesitis/enthesopathy/enthesial erosion, as tendon attachment-localized avulsions and stress fracture equivalents.

Rothschild B World J Orthop. 2024; 15(10):902-907.

PMID: 39473521 PMC: 11514551. DOI: 10.5312/wjo.v15.i10.902.

Ultrasound in the Evaluation of Dactylitis and Enthesitis in Psoriatic Arthritis.

Urruticoechea-Arana A, Moreno M, Pujol M, Clavaguera T Eur J Rheumatol. 2024; 11(3):S298-S304.

PMID: 39311552 PMC: 11459574. DOI: 10.5152/eurjrheum.2024.21096.

Tendinous Signal Alterations on MRI in the Asymptomatic Elbow: A Retrospective Cross-Sectional Study.

Valgaeren B, Van Snick E, Claikens B J Belg Soc Radiol. 2024; 108(1):69.

PMID: 39036521 PMC: 11259101. DOI: 10.5334/jbsr.3651.

References

Althoff C, Appel H, Rudwaleit M, Sieper J, Eshed I, Hamm B . Whole-body MRI as a new screening tool for detecting axial and peripheral manifestations of spondyloarthritis. Ann Rheum Dis. 2007; 66(7):983-5. PMC: 1955100. DOI: 10.1136/ard.2007.069948. View

Hermann K, Althoff C, Schneider U, Zuhlsdorf S, Lembcke A, Hamm B . Spinal changes in patients with spondyloarthritis: comparison of MR imaging and radiographic appearances. Radiographics. 2005; 25(3):559-69. DOI: 10.1148/rg.253045117. View

Resnick D, Niwayama G . Entheses and enthesopathy. Anatomical, pathological, and radiological correlation. Radiology. 1983; 146(1):1-9. DOI: 10.1148/radiology.146.1.6849029. View

Lambert R, Dhillon S, Jhangri G, Sacks J, Sacks H, Wong B . High prevalence of symptomatic enthesopathy of the shoulder in ankylosing spondylitis: deltoid origin involvement constitutes a hallmark of disease. Arthritis Rheum. 2004; 51(5):681-90. DOI: 10.1002/art.20681. View

Bezza A, Niamane R, Amine B, Maghraoui A, Bensabbah R, Hajjaj-Hassouni N . Involvement of the foot in patients with psoriatic arthritis. A review of 26 cases. Joint Bone Spine. 2004; 71(6):546-9. DOI: 10.1016/j.jbspin.2002.06.001. View

Tan A, Grainger A, Tanner S, Emery P, McGonagle D . A high-resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same?. Arthritis Rheum. 2006; 54(4):1328-33. DOI: 10.1002/art.21736. View

Haims A, Schweitzer M, Patel R, Hecht P, Wapner K . MR imaging of the Achilles tendon: overlap of findings in symptomatic and asymptomatic individuals. Skeletal Radiol. 2001; 29(11):640-5. DOI: 10.1007/s002560000273. View

Olivieri I, Barozzi L, Padula A . Enthesiopathy: clinical manifestations, imaging and treatment. Baillieres Clin Rheumatol. 1999; 12(4):665-81. DOI: 10.1016/s0950-3579(98)80043-5. View

Erdem C, Sarikaya S, Erdem L, Ozdolap S, Gundogdu S . MR imaging features of foot involvement in ankylosing spondylitis. Eur J Radiol. 2004; 53(1):110-9. DOI: 10.1016/j.ejrad.2004.03.013. View

10.

McGonagle D, Marzo-Ortega H, OConnor P, Gibbon W, Pease C, Reece R . The role of biomechanical factors and HLA-B27 in magnetic resonance imaging-determined bone changes in plantar fascia enthesopathy. Arthritis Rheum. 2002; 46(2):489-93. DOI: 10.1002/art.10125. View

11.

Hermann K, Bollow M . Magnetic resonance imaging of the axial skeleton in rheumatoid disease. Best Pract Res Clin Rheumatol. 2004; 18(6):881-907. DOI: 10.1016/j.berh.2004.06.005. View

12.

Eshed I, Althoff C, Feist E, Minden K, Schink T, Hamm B . Magnetic resonance imaging of hindfoot involvement in patients with spondyloarthritides: comparison of low-field and high-field strength units. Eur J Radiol. 2007; 65(1):140-7. DOI: 10.1016/j.ejrad.2007.03.009. View

13.

Olivieri I, Barozzi L, Padula A, De Matteis M, Pierro A, Cantini F . Retrocalcaneal bursitis in spondyloarthropathy: assessment by ultrasonography and magnetic resonance imaging. J Rheumatol. 1998; 25(7):1352-7. View

14.

Savnik A, Malmskov H, Thomsen H, Bretlau T, Graff L, Nielsen H . MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T). Eur Radiol. 2001; 11(6):1030-8. DOI: 10.1007/s003300000709. View

15.

Gasson J, Gandy S, Hutton C, Jacoby R, Summers I, Vennart W . Magnetic resonance imaging of rheumatoid arthritis in metacarpophalangeal joints. Skeletal Radiol. 2000; 29(6):324-34. DOI: 10.1007/s002560000208. View

16.

Taylor P, Stoecker W . Enthesitis of the elbow in psoriatic arthritis. J Rheumatol. 1998; 24(11):2268-9. View

17.

Rufai A, Ralphs J, Benjamin M . Structure and histopathology of the insertional region of the human Achilles tendon. J Orthop Res. 1995; 13(4):585-93. DOI: 10.1002/jor.1100130414. View

18.

Bollow M, Hermann K, Biedermann T, Sieper J, Schontube M, Braun J . Very early spondyloarthritis: where the inflammation in the sacroiliac joints starts. Ann Rheum Dis. 2005; 64(11):1644-6. PMC: 1755289. DOI: 10.1136/ard.2004.034967. View

19.

Benjamin M, McGonagle D . The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J Anat. 2002; 199(Pt 5):503-26. PMC: 1468363. DOI: 10.1046/j.1469-7580.2001.19950503.x. View

20.

Francois R, Eulderink F, Bywaters E . Commented glossary for rheumatic spinal diseases, based on pathology. Ann Rheum Dis. 1995; 54(8):615-25. PMC: 1009954. DOI: 10.1136/ard.54.8.615. View