Diagnosis and treatment of enthesitis.

The conceptual understanding of SpA and the ability to image sites of skeletal inflammation accurately and confirm that enthesitis is the primary lesion has occurred around the same time as the greatest therapeutic advances in AS and SpA with the advent of potent anti-TNF therapies for enthesitis. These therapies have transformed the understanding of enthesitis and revolutionized therapy of what was often an intractable problem. Now that clinicians better understand enthesitis-related disease mechanisms and have the ability to image them in early disease and monitor them, there is an urgent need to assess optimal conventional drug therapy in these conditions.