TY - JOUR T1 - THE FREQUENCY AND ASSOCIATED FACTORS OF CALCANEAL ENTHESITIS IN PATIENTS WITH RHEUMATOID ARTHRITIS TT - Romatoid Artrit Hastalarında Kalkaneal Entezit Sıklığı ve İlişkili Faktörler AU - Pekdiker, Mete AU - Hatık Fındıklı, Zeynep PY - 2025 DA - August Y2 - 2025 DO - 10.24938/kutfd.1546206 JF - The Journal of Kırıkkale University Faculty of Medicine JO - Kırıkkale Uni Med J PB - Kirikkale University WT - DergiPark SN - 2148-9645 SP - 120 EP - 126 VL - 27 IS - 2 LA - en AB - Objective: Chronic synovitis in peripheral joints is the hallmark lesion but enthesal involvement is little known in patients with rheumatoid arthritis (RA). The aim of this study is to draw attention to this issue by defining the frequency, and associated factors of calcaneal enthesitis (CE) in patients with RA. Material and Methods: This single-center study was conducted at our rheumatology outpatient clinic between July 2022 and December 2022. Electronic medical records was reviewed retrospectively. Patients with RA aged ≥18 years were included. Patients having any enthesitis-related non-rheumatic disorders were excluded. Calcaneal enthesitis was defined as the presence of heel pain accompanied by morning stiffness, and radiological evidence of calcaneal enthesitis (as irregular calcaneal spur). Results: We examined totally 616 cases, and 75.8% of them were female. The mean age was 50.5±14.0 years, and the mean disease duration was 7.5±7.3 years. Rheumatoid arthritis-type joint involvement was present in 92.2% (n=568) of study population. Rheumatoid factor (RF) and anti-CCP positivity was 72.6% and 71.8%, respectively. Twenty-seven patients had CE; seven of them had spondyloarthritis (four had psoriasis, two ankylosing spondylitis, one ulcerative colitis). The 3.6% (n=20) of patients had RA-related CE. In univariate analysis, CE+ group had higher age at first symptom for RA (p=0.027), less severe radiographical joint involvement (p=0.016), less RF positivity (p KW - Calcaneus KW - enthesopathy KW - rheumatoid arthritis KW - risk factor N2 - Amaç: Romatoid artrit (RA) olgularında periferik eklemlerdeki kronik sinovit temel lezyondur ancak entezal tutulum hakkında bilgi azdır. Bu çalışmanın amacı RA olgularında kalkaneal entezit (KE) sıklığını ve ilişkili faktörleri tanımlayarak bu konuya dikkat çekmektir. Gereç ve Yöntemler: Tek merkezli çalışmamız Temmuz 2022- Aralık 2022 tarihleri arasında romatoloji kliniğimize ayaktan başvuran hastalarda yapıldı. Elektronik hasta dosyaları retrospektif olarak incelendi. On sekiz yaşından büyük RA olguları çalışmaya alındı. Entezit ilişkili non-romatolojik hastalığı olanlar çalışmadan çıkarıldı. Kalkaneal entezit, sabah tutukluğunun eşlik ettiği topuk ağrısı ve radyografik bulgunun (düzensiz spur) varlığı olarak tanımlandı. Bulgular: Toplam 616 olguyu inceledik ve bunların %75,8’i kadındı. Ortalama yaş 50,5±14,0 ve ortalama hastalık süresi 7,5±7,3 yıldı. Romatoid artrit tipi eklem tutulumu çalışma grubunun %92,2’sinde (n=568) mevcuttu. Romatoid faktör (RF) ve anti-CCP antikor pozitifliği sırasıyla %72,6 ve %71,8 idi. Yirmi yedi hastada KE saptadık ve bunların yedisinde spondiloartrit (dört olguda sedef, ikisinde ankilozan spondilit, birinde ülseratif kolit) mevcuttu. Çalışma grubunun %3,6’sında (n=21) RA-ilişkili KE saptandı. Tek değişkenli analizde KE+ grup yüksek RA başlangıç yaşı (p=0,027), radyolojik olarak daha az ciddi eklem tutulumu (p=0,016), daha az RF pozitifliği (p CR - Smolen JS, Aletaha D, Barton A et al. Rheumatoid arthritis. Nat Rev Dis Primers. 2018;4:18001. CR - McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011;365(23):2205-2219. CR - Grassi W, De Angelis R, Lamanna G, Cervini C. The clinical features of rheumatoid arthritis. Eur J Radiol. 1998;27(Suppl 1):18-24. CR - Schett G, Lories RJ, D'Agostino MA et al. Enthesitis: From pathophysiology to treatment.Nat Rev Rheumatol. 2017;13(12):731-741. CR - Slobodin G, Rimar D, Boulman N et al. Entheseal involvement in systemic disorders. Clin Rheumatol. 2015;34(12):2001-2010. CR - Neogi T, Aletaha D, Silman AJ et al. The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: Phase 2 methodological report. Arthritis Rheum. 2010;62(9):2582-2591. CR - Swinkels HL, Laan RF, van 't Hof MA, van der Heijde DM, de Vries N, van Riel PL. Modified sharp method: factors influencing reproducibility and variability. Semin Arthritis Rheum. 2001;31(3):176-190. CR - Resnick D, Feingold ML, Curd J, Niwayama G, Goergen TG. Calcaneal abnormalities in articular disorders: Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and Reiter syndrome. Radiology. 1997;125(2):355-366. CR - Sebes JI. The significance of calcaneal spurs in rheumatic diseases. Arthritis Rheum. 1989;32(3):338-340. CR - van Gestel AM, Haagsma CJ, van Riel PL. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum. 1998;41(10):1845-1850. CR - Rudwaleit M, van der Heijde D, Landewé R et al. The assessment of spondyloarthritis ınternational Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70(1):25-31. CR - van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27(4):361-368. CR - Bywaters EG. Heel lesions of rheumatoid arthritis. Ann Rheum Dis. 1954;13(1):42-51. CR - Mason RM, Murray RS, Oates JK, Young AC. A comparative radiological study of Reiter's disease, rheumatoid arthritis and ankylosing spondylitis J Bone Joint Surg Br. 1959;41-B(1):137-148. CR - Bassiouni M. Incidence of calcaneal spurs in osteo-arthrosis and rheumatoid arthritis, and in control patients. Ann Rheum Dis. 1965;24(5):490-493. CR - Gerster JC, Vischer TL, Bennani A, Fallet GH. The painful heel. Comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthrosis. Ann Rheum Dis. 1977;36(4):343-348. CR - Bouysset M, Tebib J, Weil G et al. The rheumatoid heel: Its relationship to other disorders in the rheumatoid foot. Clin Rheumatol. 1989;8(2):208-214. CR - Helliwell PS, Porter G; CASPAR study group. Sensitivity and specificity of plain radiographic features of peripheral enthesopathy at major sites in psoriatic arthritis. Skeletal Radiol. 2007;36(11):1061-1066. CR - Suzuki T, Hidaka Y, Seri Y. Retrocalcaneal bursitis precedes or accompanies achilles tendon enthesitis in the early phase of rheumatoid arthritis. Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:179544118781094. CR - Falsetti P, Frediani B, Fioravanti A et al. Sonographic study of calcaneal entheses in erosive osteoarthritis, nodal osteoarthritis, rheumatoid arthritis and psoriatic arthritis. Scand J Rheumatol. 2003;32(4):229-234. CR - Abdelzaher MG, Finzel S, Abdelsalam A, Enein AF, Abdelsalam N. Ankle and foot pathologies in early rheumatoid arthritis, what can ultrasound tell us? Int J Rheum Dis. 2002;25(11):1315-1323. CR - Ramiro S, Nikiphorou E, Sepriano A et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023;82(1):19-34. CR - Jubber A, Tahir H, Moorthy A. Clinical efficacy of JAK inhibitors on enthesitis in spondyloarthropathy: A scoping literature review. Musculoskeletal Care. 2023;21(4):1195-1203. CR - Mandl P, Navarro-Compán V, Terslev L et al. European League Against Rheumatism (EULAR) recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis. 2015;74(7):1327-1339. CR - Rudwaleit M, van der Heijde D, Landewe´ R et al. The development of assessment of spondyloarthritis international society classification criteria for axial spondyloarthritis (Part II): Validation And Final Selection. Ann Rheum Dis. 2009;68(6):777-783. CR - Acar M, Cora T, Tunc R, Acar H. HLA-B27 subtypes in Turkish patients with ankylosing spondylitis and healthy controls. Rheumatol Int. 2012;32(10):3103-3105. CR - Mera-Varela A, Ferreiro-Iglesias A, Perez-Pampin E, Porto-Silva M, Gómez-Reino JJ, Gonzalez A. Ultrasonographic assessment of enthesitis in HLA-B27 positive patients with rheumatoid arthritis, A matched case-only study. PLoS One. 2013;8(3):e58616. UR - https://doi.org/10.24938/kutfd.1546206 L1 - https://dergipark.org.tr/en/download/article-file/4200995 ER -