title: The problem in differentiation between psoriatic-related polyenthesitis and fibromyalgia.
abstract: The recognition of the primacy of enthesitis in animal models of spondyloarthritis and the prevalence of clinically occult enthesopathy in psoriatic subjects and of persistent joint pain in PsA subjects who have ostensibly good reduction of joint swelling under biological therapy has highlighted the potential impact of polyenthesitis in psoriatic disease. In daily practice, the formal demonstration of enthesitis is challenging for the following reasons: the relatively avascular nature of enthesis, often leading to the absence of overt clinical inflammatory signs; the frequent lack of elevation of inflammatory markers; and finally, the limitations of current imaging techniques to provide supportive evidence for inflammation in these areas. Consequently, enthesitis may present as widespread pain indistinguishable from FM or may emerge as the dominant feature after successful biological therapy for suppression of synovitis. The unmet needs in the differentiation between FM and enthesitis in psoriatic disease patients are highlighted and critically evaluated in this article.
authors.affiliation: UOC Day Hospital of Rheumatology, ASST Gaetano Pini-CTO Hospital, Milano, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marchesoni
authors.affiliation: NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust.|Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.
authors.forename: Gabriele
authors.initials: G
authors.lastname: De Marco
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Mira
authors.initials: M
authors.lastname: Merashli
authors.affiliation: Rheumatology Department, Central Manchester University Hospitals NHS Trust, Trafford General Hospital, Manchester, UK.
authors.forename: Frank
authors.initials: F
authors.lastname: McKenna
authors.affiliation: Unit of Rheumatology, Sacro Cuore Don Calabria Hospital, Negrar, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Tinazzi
authors.affiliation: NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust.|Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.
authors.forename: Helena
authors.initials: H
authors.lastname: Marzo-Ortega
authors.affiliation: NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust.|Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.
authors.forename: Dennis G
authors.initials: DG
authors.lastname: McGonagle
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D001688:Biological Products / Q000627:therapeutic use; D003937:Diagnosis, Differential; D000070676:Enthesopathy / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005356:Fibromyalgia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D011877:Radionuclide Imaging; D025242:Spondylarthropathies / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D014463:Ultrasonography
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: MRI; biological therapies; chronic pain syndromes; diagnostic imaging; fibromyalgia; inflammation; radionuclide imaging; soft tissue rheumatism; spondylarthropathies; ultrasonography