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Histological assessment of the early enthesitis lesion in spondyloarthropathy
  1. D McGonagle1,2,
  2. H Marzo-Ortega1,
  3. P O'Connor3,
  4. W Gibbon4,
  5. P Hawkey5,
  6. K Henshaw1,
  7. P Emery1
  1. 1Rheumatology and Rehabilitation Research Unit, University of Leeds, 36 Clarendon Road, Leeds LS2 9NZ, UK
  2. 2Calderdale Royal Hospital, Salterhebble, Halifax HX3 0PW, UK
  3. 3Department of Radiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
  4. 4Department of Radiology, Royal Brisbane Hospital, Herston Road, Herston, Brisbane QLD 4029, Australia
  5. 5Department of Microbiology, University of Birmingham, Medical School, Edgbaston, Birmingham, B15 2TT, UK
  1. Correspondence to:
    Dr D McGonagle, Rheumatology and Rehabilitation Research Unit, University of Leeds, 36 Clarendon Road, Leeds LS2 9NZ, UK;


Objectives: To describe the histological changes in acute enthesopathy in early spondyloarthropathies (SpA).

Methods: Clinically evident acute enthesopathy was confirmed by magnetic resonance imaging and ultrasonography in four cases of plantar fasciitis and one case of patellar tendon enthesitis. Ultrasound guided biopsy of insertional points was carried out with a Jamshedi needle. Control tissue was obtained from two subjects undergoing spinal grafting surgery. Standard histochemistry and immunohistochemistry analysis using the avidin-biotin immunoperoxidase complex method employing markers against CD3, CD8, CD34, and CD68 was used to determine cellular infiltrates at the insertion point.

Results: The enthesis architecture was abnormal in the SpA group, with increased vascularity and cellular infiltration compared with normal subjects. The predominant infiltrating cell at the enthesis fibrocartilage was the macrophage, but there was a paucity of lymphocytes at the insertion point.

Conclusion: These preliminary findings have implications for a better understanding of the pathology in early SpA.

  • enthesitis
  • spondyloarthropathy
  • magnetic resonance imaging
  • histology
  • ABC, avidin-biotin immunoperoxidase complex
  • AS, ankylosing spondylitis
  • FOV field of view
  • FS, fat suppressed
  • NSA, number of signals averaged
  • SE, spin echo
  • SpA, spondyloarthropathies
  • TBS, Tris buffered saline
  • TE, time to echo
  • TNFα, tumour necrosis factor α
  • TR, repetition time

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