Psoriatic Arthritis and Psoriasis by Adewale Adebajo Wolf-Henning Boehncke Dafna D. Gladman & Philip J. Mease

Author:Adewale Adebajo, Wolf-Henning Boehncke, Dafna D. Gladman & Philip J. Mease
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Hypothesis of the ‘Synovio-Entheseal Complex’

Experimental models of inflammatory arthritis with features of Psoriatic Arthritis demonstrate that the disease process starts at the enthesis [32–34]. These models confirm imaging findings in PsA and SpA patients [22, 35]. However, it is difficult to prove this hypothesis because of the limitations in conserving tissue samples easily.

Enthesiopathy can be measured by ultrasound. It is very common in patients with psoriasis without clinical manifestations of arthritis suggesting that it might be a primary abnormality [36]. The presence of clinically silent enthesiopathy in psoriasis appears to be associated with the subsequent development of Psoriatic Arthritis [37]. Synovitis or joint swelling in Psoriatic Arthritis may be linked to dysfunction of the enthesis where it forms tissue structures called ‘synovio-entheseal complexes’ (SECs) [38]. Osteitis or bone inflammation appears frequently in PsA patients. The enthesis and the underlying bone are functionally integrated with the enthesis being anchored to the underlying bone. Nail disease in psoriasis patients is a risk factor for development of PsA. It has been demonstrated that the nail is anchored directly to the skeleton by ligament and tendon entheses [39]. This may offer a new explanation for a possible link between nail disease and arthritis. Taken together, Psoriatic Arthritis might start at the insertions before spreading to other sites.

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