THE SIGNIFICANCE OF ENTHESOPATHY AS A SKELETAL PHENOMENON
ankylosing spondylitis; arthropathy; calcium pyrophosphate; crystal deposition disease; defleshed bones; deposition disease; enthesitis; erosive arthritis; lesions; rheumatoid-arthritis; rheumatoid-arthritis; Rheumatology; spondyloarthropathies
Enthesophytes and enthesopathy, while easy to define, represent a phenomenon of unclear clinical significance. As the high frequency in skeletal populations suggests that enthesopathy may not be disease-specific, the nature of the reaction was assessed in 872 individuals from a representative skeletal population, subdivided into groups characterized by the presence or absence of rheumatoid arthritis, spondyloarthropathy, calcium pyrophosphate deposition disease and diffuse idiopathic skeletal hyperostosis (DISH). Achilles, plantar fascia, patellar and iliac crest entheses were examined for evidence of calcific overgrowth or ''erosions.'' Enthesophytes were found to be a phenomenon of aging in individuals, and unrelated to the presence of inflammatory arthritis or DISH. The frequency increased with age, independent of sex or the site examined, plateauing infrequency after age 60. Enthesophytes in individuals under age 60 were usually unrelated to any underlying disorder. The absence of effect of underlying forms of arthritis on the frequency of enthesophytes at the patellar, Achilles and plantar sites suggests that mechanical factors outweigh the ''enthesis calcifying '' impact of such disorders as spondyloarthropathy, calcium pyrophosphate deposition disease and DISH. Individuals with rheumatoid arthritis, however, manifested a less severe iliac crest enthesial reaction, in keeping with the minimal reactive new bone formation characteristic of its erosions. Analysis of Achilles, plantar, and patellar enthesial reactions as a function of underlying inflammatory arthritis or DISH also revealed no significant variation with the underlying process. Cortical discontinuity at enthesial sites was a relatively infrequent phenomenon. While calcaneal discontinuities were originally thought to be erosive in nature, these observations suggest the possibility of tendon avulsion injuries.
Shaibani A; Workman R; Rothschild B M
Clinical and Experimental Rheumatology
1993
1993-07
Journal Article
n/a
CALCIUM PYROPHOSPHATE DEPOSITION DISEASE - DESCRIPTION IN DEFLESHED SKELETONS
arthritis; bones; calcium pyrophosphate; chondrocalcinosis articularis; deposition disease; destructive arthropathy; disease; erosive arthritis; indians; paleopathology; Pathology; pseudogout; rheumatoid-arthritis; Rheumatology
The osseous appearance, skeletal distribution, and distinguishing features of calcium pyrophosphate deposition disease (CPPD) were delineated in a population of 2906 contemporary defleshed skeletons. The limitations of routine x-ray and clinical examination were transcended in this study of defleshed bones. The nature of the disease was clearly identified and preconceived notions (based on the ''shades of black and white'' of the conventional x-rav technique) were examined on the basis of the actual osseous impact. Epidemiologic assessment of this disease allowed it to be distinguished from rheumatoid and other erosive forms of arthritis. Analysis of the ''pseudo-rheumatoid'' subgroup of CPPD provided clear criteria for distinguishing the disease from rheumatoid arthritis. Characterization of the nature and epidemiology of osseous alterations in a contemporary skeletal population permitted the development of a standard for recognition of CPPD in skeletal populations and for clarification of the nature of associated pseudo-erosions.
Rothschild B M; Woods R J; Rothschild C
Clinical and Experimental Rheumatology
1992
1992-11
Journal Article
n/a