Enthesitis in psoriatic disease.

Enthesitis is increasingly recognized as an important component in psoriatic arthritis (PsA). Improved imaging techniques have expanded our understanding of the role of enthesitis in PsA and provided methods for earlier detection and assessment. Increased knowledge about the extent of tendon and ligament involvement has led to the theory that enthesitis may be the primary event in PsA. Given the historical difficulties in detecting and measuring enthesitis, its inclusion as an endpoint in PsA trials has been limited. Current trial data suggest that tumour necrosis factor inhibitors can successfully treat PsA-related enthesitis, which may have implications for the long-term prognosis of PsA. In this article, we review methods for detecting and assessing enthesitis, current thinking regarding the role of enthesitis in the pathogenesis of PsA, and trial evidence for the treatment of PsA and, therefore, enthesitis.