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Metabolic syndrome associated to non-inflammatory Achilles enthesopathy

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Abstract

Enthesopathies are frequently found in rheumatic inflammatory diseases, but can be observed also in absence of systemic inflammation. Aging, overuse, and microtraumas can be responsible for enthesis-degenerative phenomena. Despite that Achilles enthesis is the more frequently affected, no systematic study on the risk factors associated to this enthesopathy has been yet performed. The aim of this paper was to assess whether the metabolic syndrome could be associated to entheseal lesions. Forty-five subjects with symptomatic non-inflammatory Achilles enthesopathy were compared to 45 asymptomatic controls. An ultrasound study of the Achilles enthesis was carried out, and the presence/absence of lesions (morphologic abnormalities, calcific deposits, enthesophytes, cortical abnormalities, and adjacent bursitis) was assessed. On the basis of history, comorbidities (osteoarthritis, diabetes, and hypertension) were recorded. In each subject, body mass index (BMI), glucose, total, and HDL cholesterol were also evaluated. All symptomatic subjects showed at ultrasound evaluation at least one structural entheseal alteration; pathologic features in asymptomatic subjects were found in 6/45 (13.3 %) of cases. Higher values of BMI and glucose were found in subjects with symptomatic enthesopathy. At multiple logistic regression analysis, the presence of high values of BMI and glucose was related to a higher probability to detect entheseal lesions. Metabolic syndrome and overweight may have a role in the pathogenesis of Achilles enthesopathy due to their synergistic worsening effect on other pathogenetic factors of tendon degeneration, such age and overuse. Therefore, subjects with metabolic syndrome practicing sports and other activities stressing the Achilles tendon should receive advice for more frequent controls.

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References

  1. Benjamin M, Mcgonagle D (2009) Entheses: tendon and ligament attachment sites. Scand J Med Sci Sports 19(4):520–527

    Article  PubMed  CAS  Google Scholar 

  2. Baraliakos X, Braun J (2011) Spondyloarthritides. Best Pract Res Clin Rheumatol 25(6):825–842

    Article  PubMed  Google Scholar 

  3. Woodburn J, Hyslop E, Barn R, McInnes IB, Turner DE (2013) Achilles tendon biomechanics in psoriatic arthritis patients with ultrasound proven enthesitis. Scand J Rheumatol 42(4):299–302

    Article  PubMed  CAS  Google Scholar 

  4. Bandinelli F, Prignano F, Bonciani D, Bartoli F, Collaku L, Candelieri A, Lotti T, Matucci CM (2013) Ultrasound detects occult entheseal involvement in early psoriatic arthritis independently of clinical features and psoriasis severity. Clin Exp Rheumatol 31(2):219–224

    PubMed  Google Scholar 

  5. Freeston JE, Coates LC, Helliwell PS, Hensor EM, Wakefield RJ, Emery P, Conaghan PG (2012) Is there subclinical enthesitis in early psoriatic arthritis? A clinical comparison with power doppler ultrasound. Arthritis Care Res (Hoboken) 64(10):1617–1621

    Article  CAS  Google Scholar 

  6. Shaw HM, Benjamin M (2007) Structure-function relationships of entheses in relation to mechanical load and exercise. Scand J Med Sci Sports 17(4):303–315

    Article  PubMed  CAS  Google Scholar 

  7. Benjamin M, Toumi H, Ralphs JR, Bydder G, Best TM, Milz S (2006) Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. J Anat 208(4):471–490

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. Syha R, Springer F, Ketelsen D, Ipach I, Kramer U, Horger M, Schick F, Grosse U (2013) Achillodynia—radiological imaging of acute and chronic overuse injuries of the achilles tendon. Rofo 185(11):1041–1055

    Article  PubMed  CAS  Google Scholar 

  9. Stenroth L, Peltonen J, Cronin NJ, Sipilä S, Finni T (1985) Age-related differences in Achilles tendon properties and triceps surae muscle architecture in vivo. J Appl Physiol 113(10):1537–1544

    Article  Google Scholar 

  10. Houghton L, Dawson B, Rubenson J (2013) Achilles tendon mechanical properties after both prolonged continuous running and prolonged intermittent shuttle running in cricket batting. J Appl Biomech 29(4):453–462

    PubMed  Google Scholar 

  11. Abate M, Silbernagel KG, Siljeholm C et al (2009) Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Res Ther 11(3):235

    Article  PubMed  PubMed Central  Google Scholar 

  12. Menz HB, Zammit GV, Landorf KB, Munteanu SE (2008) Plantar calcaneal spurs in older people: longitudinal traction or vertical compression? J Foot Ankle Res 1(1):7

    Article  PubMed  PubMed Central  Google Scholar 

  13. Irving DB, Cook JL, Menz HB (2006) Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport 9(1–2):11–22, discussion 23-4

    Article  PubMed  CAS  Google Scholar 

  14. Balint PV, Kane D, Wilson H, Mcinnes IB, Sturrock RD (2002) Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 61(10):905–910

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  15. Ohberg L, Lorentzon R, Alfredson H (2001) Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Fknee Surg Sports Traumatol Arthrosc 9(4):233–238

    Article  CAS  Google Scholar 

  16. Ball J (1971) Enthesopathy of rheumatoid and ankylosing spondylitis. Ann Rheum Dis 30(3):213–223

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  17. McGonagle D, Lories RJ, Tan AL, Benjamin M (2007) The concept of a “synovio-entheseal complex” and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum 56(8):2482–2491

    Article  PubMed  Google Scholar 

  18. Abate M, Schiavone C, Salini V, Andia I (2013) Occurrence of tendon pathologies in metabolic disorders. Rheumatology (Oxford) 52(4):599–608

    Article  CAS  Google Scholar 

  19. Degroot J (2004) The AGE of the matrix: chemistry, consequence and cure. Curr Opin Pharmacol 4(3):301–305

    Article  PubMed  CAS  Google Scholar 

  20. Vazzana N, Santilli F, Cuccurullo C, Davì G (2009) Soluble forms of RAGE in internal medicine. Intern Emerg Med 4(5):389–401

    Article  PubMed  Google Scholar 

  21. Alikhani Z, Alikhani M, Boyd CM, Nagao K, Trackman PC, Graves DT (2005) Advanced glycation end products enhance expression of pro-apoptotic genes and stimulate fibroblast apoptosis through cytoplasmic and mitochondrial pathways. J Biol Chem 280(13):12087–12095

    Article  PubMed  CAS  Google Scholar 

  22. Gaida JE, Cook JL, Bass SL (2008) Adiposity and tendinopathy. Disabil Rehabil 30(20–22):1555–1562

    Article  PubMed  CAS  Google Scholar 

  23. Abate M, Schiavone C, Di Carlo L, Salini V (2012) Achilles tendon and plantar fascia in recently diagnosed type II diabetes: role of body mass index. Clin Rheumatol 31(7):1109–1113

    Article  PubMed  Google Scholar 

  24. Abate M, Oliva F, Schiavone C, Salini V (2012) Achilles tendinopathy in amateur runners: role of adiposity (tendinopathies and obesity). Muscles Ligaments Tendons J 2(1):44–48

    PubMed  PubMed Central  Google Scholar 

  25. Conde J, Scotece M, Gómez R et al (2011) Adipokines: biofactors from white adipose tissue. A complex hub among inflammation, metabolism, and immunity. Biofactors 37(6):413–420

    Article  PubMed  CAS  Google Scholar 

  26. Lago R, Gómez R, Lago F, Gómez-Reino J, Gualillo O (2008) Leptin beyond body weight regulation—current concepts concerning its role in immune function and inflammation. Cell Immunol 252(1–2):139–145

    Article  PubMed  CAS  Google Scholar 

  27. Berry PA, Jones SW, Cicuttini FM, Wluka AE, Maciewicz RA (2011) Temporal relationship between serum adipokines, biomarkers of bone and cartilage turnover, and cartilage volume loss in a population with clinical knee osteoarthritis. Arthritis Rheum 63(3):700–707

    Article  PubMed  CAS  Google Scholar 

  28. Cilli F, Khan M, Fu F, Wang JH (2004) Prostaglandin E2 affects proliferation and collagen synthesis by human patellar tendon fibroblasts. Clin J Sport Med 14(4):232–236

    Article  PubMed  Google Scholar 

  29. Battery L, Maffulli N (2011) Inflammation in overuse tendon injuries. Sports Med Arthrosc 19(3):213–217

    Article  PubMed  Google Scholar 

  30. Boesen AP, Boesen MI, Torp-Pedersen S et al (2012) Associations between abnormal ultrasound color Doppler measures and tendon pain symptoms in badminton players during a season: a prospective cohort study. Am J Sports Med 40(3):548–555

    Article  PubMed  Google Scholar 

  31. Wiell C, Szkudlarek M, Hasselquist M et al (2013) Power Doppler ultrasonography of painful Achilles tendons and entheses in patients with and without spondyloarthropathy: a comparison with clinical examination and contrast-enhanced MRI. Clin Rheumatol 32(3):301–308

    Article  PubMed  Google Scholar 

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Acknowledgments

This work has not been published previously, it is not under consideration for publication elsewhere, and its publication is approved by all authors and by the responsible authorities where the work was carried out.

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The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Medicine and Science of Aging, University G. d’Annunzio, Chieti-Pescara, Via dei Vestini 31, 66013, Chieti Scalo, CH, Italy

    Michele Abate, Luigi Di Carlo, Vincenzo Salini & Cosima Schiavone

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  1. Michele Abate
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  2. Luigi Di Carlo
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  3. Vincenzo Salini
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  4. Cosima Schiavone
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Correspondence to Michele Abate.

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Abate, M., Di Carlo, L., Salini, V. et al. Metabolic syndrome associated to non-inflammatory Achilles enthesopathy. Clin Rheumatol 33, 1517–1522 (2014). https://doi.org/10.1007/s10067-014-2524-3

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  • DOI: https://doi.org/10.1007/s10067-014-2524-3

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