Enthesopathies - Mechanical, inflammatory or both?

Entheses have the challenging task of transferring biomechanical forces between tendon and bone, two tissues that differ greatly in composition and mechanical properties. Consequently, entheses are adapted to withstand these forces through continuous repair mechanisms. Locally specialized cells (mechanosensitive tenocytes) are crucial in the repair, physiologically triggering biochemical processes to maintain hemostasis. When repetitive forces cause "material fatigue," or trauma exceeds the entheses' repair capacity, structural changes occur, and patients become symptomatic. Clinical assessment of enthesopathies mainly depends on subjective reports by the patient and lacks specificity, especially in patients with central sensitization syndromes. Ultrasonography has been increasingly used to improve the diagnosis of enthesopathies. In this article, the literature on how biomechanical forces lead to entheseal inflammation, including factors contributing to differentiation into a "clinical enthesitis" state and the value of ultrasound to diagnose enthesopathies will be reviewed, as well as providing clues to overcome the pitfalls of imaging.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: S.Z.A. has received grants or contracts from Abbvie, Celgene, Eli Lilly, Jannsen, Novartis, Pfizer, Sanofi, and UCB; consultant's fees from Abbvie, Celgene, Eli Lilly, Novartis, Pfizer, Sanofi, and UCB; payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing, or educational events from Abbvie, Jannsen, Novartis, Pfizer, and UCB; support for meeting attendance from Abbvie, Pfizer, Novartis, and Sandoz; and stock options in Clarius. X.B. has received research support from AbbVie, Novartis, MSD; Consultant, Speakers Bureau, Scientific Advisory Board, and Honoraria: AbbVie, Amgen, BMS, Chugai Galapagos, Gilead, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, UCB. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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