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Review
. 2023 Apr;75(4):493-498.
doi: 10.1002/art.42299. Epub 2023 Jan 15.

Concepts of Entheseal Pain

Enrico De Lorenzis  1 , Gerlando Natalello  1 , David Simon  2 , Georg Schett  2 , Maria Antonietta D'Agostino  1
Affiliations
Review

Concepts of Entheseal Pain

Enrico De Lorenzis et al. Arthritis Rheumatol. 2023 Apr.

Abstract

Pain is the main symptom in entheseal diseases (enthesopathies) despite a paucity of nerve endings in the enthesis itself. Eicosanoids, cytokines, and neuropeptides released during inflammation and repeated nonphysiologic mechanical challenge not only stimulate or sensitize primary afferent neurons present in structures adjacent to the enthesis, but also trigger a "neurovascular invasion" that allows the spreading of nerves and blood vessels into the enthesis. Nociceptive pseudounipolar neurons support this process by releasing neurotransmitters from peripheral endings that induce neovascularization and peripheral pain sensitization. This process may explain the frequently observed dissociation between subjective symptoms such as pain and the structural findings on imaging in entheseal disease.

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References

REFERENCES

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