Tendons--time to revisit inflammation

Abstract

It is currently widely accepted among clinicians that chronic tendinopathy is caused by a degenerative process devoid of inflammation. Current treatment strategies are focused on physical treatments, peritendinous or intratendinous injections of blood or blood products and interruption of painful stimuli. Results have been at best, moderately good and at worst a failure. The evidence for non-infammatory degenerative processes alone as the cause of tendinopathy is surprisingly weak. There is convincing evidence that the inflammatory response is a key component of chronic tendinopathy. Newer anti-inflammatory modalities may provide alternative potential opportunities in treating chronic tendinopathies and should be explored further.

Keywords: Immune Function; Immunology; Tendons.

Figure 1

Power Doppler ultrasound in ‘overuse’ and ‘inflammatory’ tendon disorders. Sonographically it is often impossible to determine the cause of tendinopathy from Power Doppler signals. The top row of images are all of patients without underlying rheumatological diagnosis and in whom mechanical overload or injury was the cause of the tendinopathy (from left to right insertional Achilles tendinopathy, proximal patellar tendon pathology and mid-peroneal tendon pathology). The bottom row of images is of patients with a known inflammatory rheumatological diagnosis. From left to right tibialis posterior tendinopathy (in RA) and insertional Achilles tendinopathy in a patient with reactive arthritis (longitudinal and transverse sections).