Enthesiopathy and bone disease during the course of inflammatory spondylarthropathies. Diagnostic and physiopathologic importance

Our studies concerning enthesopathies during the course of spondylarthropathies show that enthesopathies are very frequent: 58% among 48 spondylarthropathies in a preliminary study. The comparison of the frequency of enthesopathies in spondylarthropathies (58%) and in Rheumatoid Arthritis (6.6%) show a highly significant difference. In our latest study enthesopathies were found in 67% among 115 spondylarthropathies. We have also described the mean locations and clinical features. They are observed early in the course of the disease. Histological studies of enthesopatic and normal enthesis were also performed. They were unable to find a specific image. Nevertheless inflammatory changes in some of our cases and in cases retrieved in the medical literature confirm the involvement of enthesis in the pathological process of spondylarthropathies. Enthesopathies represent a very good diagnostic symptom. They are the hallmark of spondylarthropathies for adults and even more for children. Furthermore, if one admits the assertion that peripheral and spinal involvement is the result of bone remodeling enthesitic lesions, then enthesopathies and osteitis, ending in ankylosis, may be considered as the fundamental pathophysiological mechanism of spondylarthropathies in contrast with erosive lesions of rheumatoid arthritis.