[Enthesopathies in ankylosing spondylitis and seronegative inflammatory rheumatism. 28 cases]

A few demonstrative cases of severe and disabling enthesopathy in patients with ankylosing spondylitis (AS) and related syndromes, psoriatic arthritis (PA) or Reiter's disease (RD) have prompted the authors to investigate the incidence of enthesopathy in such patients. A retrospective clinical and radiological study was conducted in 48 patients (mean age: 34.8 years) 27 of whom had AS, 9 RD and 12 PA. The overall incidence of enthesopathy was 58.3%. Beside the classical calcaneal lesions (50%), extracalcaneal manifestations of the disease involving the knees and shoulders were found in 39% of the patients. The HLA B27 antigen was detected in 87% of patients with enthesopathy, while 82% had clinical inflammation of the spine. The mean duration of clinical symptoms due to enthesopathy was 2-6 weeks in 36% and 6 months to 1 year in 45%. One striking feature of enthesopathy in this series was the lack of response to steroidal and non-steroidal anti-inflammatory drugs contrasting with the response of the associated arthritis. Since enthesopathies appear to be of diagnostic significance in the group of arthropathies of the spine, their incidence in other articular diseases should be the object of systematic comparative evaluations. A diffuse exacerbation of enthesopathy may constitute the initial manifestation of seronegative HLA B27 positive arthropathy, which is not without therapeutic implications.