Affiliations: [a] Physical Medicine and Rehabilitation Department, Feni Diabetes Hospital (FDH), Feni, Bangladesh | [b] Physical Medicine and Rehabilitation Department, Rajshahi Medical College, Rajshahi, Bangladesh | [c] Rheumatology Department, Faculty of Behavioral sciences, University of Twente, Enschede, The Netherlands
Correspondence:
[*]
Corresponding author: Md Abu Bakar Siddiq, Physical Medicine and Rehabilitation Department, Feni Diabetes Hospital (FDH), Feni-3900, Bangladesh. Tel.: +88 01718 133427; Fax: +88 0331 63491; E-mail:abusiddiq37@yahoo.com
Abstract:
BACKGROUND: Enthesitis is a prominent feature of
spondyloarthropathy (SpA) and persisting enthesitis may be a presenting
symptom either alone or in combination with peripheral synovitis and/or
inflammatory back pain. OBJECTIVE: To describe a series of SpA patients with persistent
enthesitis as first manifestation. METHODS: This is a cross-sectional study. All SpA patients visiting
the rheumatology and rehabilitation clinic, of Chittagong Medical College Hospital, between May 2007 and December 2008, were studied and those with
chronic enthesitis as presenting symptom were included. Patients were
classified with European Spondyloarthropathy Study Group (ESSG)
classification criteria for SpA. Demographic data were collected and routine
lab tests performed, including HLA-B-27 testing.
In all patients X-ray of spinal segments, sacroiliac
joints and pelvis were performed.
Collected data were analyzed using SPSS package program (version 12.0) and
multivariate analysis was done. RESULTS: A total of 71 SpA patients could be included with initial
presentation with chronic enthesitis. Of these patients 20 gave a history of
disease onset before their 16th birthday and in 51 cases it was after
their sixteenth. The mean age at presentation was respectively 12.5 ± 2.5
and 23.3 ± 6.4 years in juvenile and adult cases. Enthesitis was defined
by history, clinical examination, and radio-imaging at accessible sites
(X-ray pelvis/foot). Enthesitis presenting in the heel was the most common
site (n= 51), but it was also seen in other locations in another 20 patients.
The mean duration between presenting enthesitis and other features of SpA
was 7.7 ± 3.2 and 8.5 ± 2.2 months in juvenile and adult cases
respectively. All patients had raised ESR at disease onset and HLA-B27 was
found to be positive in 58 cases. Ankylosing spondylitis (AS) was diagnosed
in 49 cases and GradeI-II, Grade-III, and Grade-IV sacroiliitis was
documented in 31, 5, and 13 patients respectively. CONCLUSION: Persistent enthesitis is one of the most common clinical presentation of
SpA usually associated with high ESR, HLA-B27 positivity. Definition and
classification of enthesitis is important in early diagnosis of this
rheumatologic condition.
