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Calcaneal Lesions Found In Erosive Osteoarthritis Similar To Those In Nodal Osteoarthritis
Scandinavian Journal of Rheumatology
12/04/2003
By Mary Beth Nierengarten
In patients with various clinical manifestations of hand osteoarthritis, the frequency of calcaneal lesions found in erosive osteoarthritis (EOA) is similar to those found in nodal osteoarthritis (NOA) as detected by ultrasonography. In addition, ultrasonography is comparable to radiography in detecting entheseal cortical bone abnormalities, reports a study from Italy.
Since pathological abnormalities of the calcaneal entheses often are observed in many articular diseases, an examination of these abnormalities can help with a differential diagnosis of both inflammatory and degenerative rheumatic diseases. An excellent, easy to perform, and inexpensive diagnostic tool to detect soft tissues and cortical bone involvement in rheumatic disease is ultrasonography (US).
Paolo Falsetti, MD and colleagues, University of Siena, used US to examine patients with various clinical manifestations of hand osteoarthritis to establish the prevalence of calcaneal entheses lesions in these different conditions. Included in the study were 56 patients with EOA, 209 with NOA, 158 with rheumatoid arthritis (RA), and 125 with psoriatic arthritis (PsA). Detection of calcaneal lesions made by US were then compared to detection made by radiography.
Among the 4 diseases, US revealed no significant difference in inferior calcaneal enthesophytosis. The frequency of posteroinferior enthesophytosis was lower in RA (34%) compared to EOA (57%), NOA (47%), and PsA (49%). The frequency of retrocalcaneal bursitis, posterior erosions, inferior erosions, and subcalcaneal panniculitis were higher in RA than PsA (18% vs. 6%; 12% vs. 5%; 6% vs. 1%; 10% vs. 1%; respectively). Achilles enthesitis occurred more frequently in PsA than RA (8% vs. 2%, respectively). The frequency of plantar fasciitis was highest in PsA (37%), followed by RA (26%), NOA (15%), and EOA (12%).
Using Kappa statistics, excellent agreement was found between US and radiography in the detection of entheseal erosions, and posterior and inferior enthesophytosis.
The authors conclude that "the frequency of calcaneal enthesophytosis was similar in EOA, NOA, and PsA, but inflammatory lesions of calcaneal entheses and of the adjacent bursae were more frequent in RA and in PsA: calcaneal lesions in EOA were therefore similar to those observed in NOA."
Scand J Rheumatol 2003;32:229-234.
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