0:00

<v ->And of course we see enthesitis

0:02

in the central skeleton as well.

0:05

Involvement of the ischial tuberosities are characteristic.

0:09

The area where the hamstring tendons attach

0:14

can be and often is bilateral,

0:16

but it also can be unilateral,

0:18

and in this case, associated with hip involvement.

0:22

Many years ago, we wrote an article

0:24

about the pattern of hip involvement

0:26

in ankylosing spondylitis.

0:28

And I'll just briefly tell you what the classic finding is,

0:31

'cause it's here.

0:32

Bilateral symmetrical involvement,

0:35

with diffuse loss of joint space in the hips

0:38

and a ring of osteophytes that grows

0:40

across the head-neck junction.

0:42

See it nicely on this side.

0:44

That's a characteristic, probably diagnostic,

0:47

of ankylosing spondylitis.

0:50

Here we see involvement of the trochanter.

0:53

Again, this is enthesitis in patient

0:56

with ankylosing spondylitis, marrow edema.

1:00

And even at the heel, superior aspect

1:03

of the calcaneus in the area, the retrocalcaneal bursa,

1:08

the plantar aspect of the bone,

1:10

near or at the attachment of portions of the plantar fascia.

1:15

Now in rheumatoid, you might see something like this,

1:19

but on the plantar aspect of the calcaneus and rheumatoid,

1:23

you generally see little or nothing.

1:27

So if you have extensive bone proliferation

1:29

on the plantar surface,

1:31

particularly associated with marrow edema, you wanna say,

1:35

"Gee, this is probably a spondylo arthropathy."

1:38

Here's another case, beautiful case,

1:41

studied by a fluid sensitive sequence on the left,

1:44

IV gadolinium on the right,

1:46

enhancement in those same two areas,

1:50

retrocalcaneal bursitis, Achilles tendinosis,

1:54

some would argue maybe some low grade interstitial tearing,

1:58

plantar fascial changes, plantar calcaneal enthesophyte,

2:03

that's edematous, and edema within the calcaneus itself.