THE FREQUENCY AND ASSOCIATED FACTORS OF CALCANEAL ENTHESITIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Year 2025, Volume: 27 Issue: 2, 120 - 126, 25.08.2025

Zeynep Hatık Fındıklı Mete Pekdiker

https://doi.org/10.24938/kutfd.1546206

Abstract

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<0.001), and less anti-CCP (p<0.001) positivity. Additionally, CE+ group had less biologic agent use (p<0.001). In multivariate analysis including age at first symptom, severe joint involvement, RF, and anti-CCP, there was no independent predictive factor for CE.
Conclusion: Enthesal sites may become a relevant domain of musculoskletal assessment of RA in future. Prospective studies using more sensitive imaging methods are needed to elucidate this issue.

Keywords

Calcaneus , enthesopathy , rheumatoid arthritis , risk factor

Ethical Statement

The study was approved by the ethical committee of Hatay Mustafa Kemal University (date: 07.26.2023, number: 07).

Supporting Institution

None.

Thanks

None.

Romatoid Artrit Hastalarında Kalkaneal Entezit Sıklığı ve İlişkili Faktörler

Abstract

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<0,001) ve daha az anti-CCP pozitifliğine (p<0,001) sahipti. Ayrıca, KE+ grupta biyolojik ajan kullanımı daha azdı. Çok değişkenli analizde ise KE için bağımsız prediktif faktör saptanmadı.
Sonuç: Entezal bölgeler, gelecekte RA olgularında kas-iskelet sistemi değerlendirilmesinde yer alabilir. Bu konunun açıklanması için daha sensitif görüntüleme yöntemleri ile yapılan prospektif çalışmalara ihtiyaç vardır.

Keywords

Topuk , entezopati , romatoid artrit , risk faktörü

Ethical Statement

Hatay Mustafa Kemal Üniversitesi Etik Kurul'u tarafından 26.07.2023 tarihinde 07 sayılı karar ile onaylanmıştır.

Supporting Institution

Yok.

Thanks

Yok.

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