Skip to main content

Main menu

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • COVID-19 and Rheumatology
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • JRheum Supplements
  • Services

User menu

  • My Cart
  • Log In

Search

  • Advanced search
The Journal of Rheumatology
  • JRheum Supplements
  • Services
  • My Cart
  • Log In
The Journal of Rheumatology

Advanced Search

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • COVID-19 and Rheumatology
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • Follow jrheum on Twitter
  • Visit jrheum on Facebook
  • Follow jrheum on LinkedIn
  • Follow jrheum on YouTube
  • Follow jrheum on Instagram
  • Follow jrheum on RSS
LetterCorrespondence

Bone Proliferation in Ankylosing Tarsitis Might Involve Mechanical Stress, and Hormonal and Growth Factors

CÉSAR PACHECO-TENA, SUSANA A. GONZÁLEZ-CHÁVEZ, CELIA QUIÑONEZ-FLORES and RUBÉN BURGOS-VARGAS
The Journal of Rheumatology November 2015, 42 (11) 2210; DOI: https://doi.org/10.3899/jrheum.150475
CÉSAR PACHECO-TENA
Facultad de Medicina, Universidad Autónoma de Chihuahua;
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
SUSANA A. GONZÁLEZ-CHÁVEZ
Facultad de Medicina, Universidad Autónoma de Chihuahua;
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
CELIA QUIÑONEZ-FLORES
Facultad de Medicina, Universidad Autónoma de Chihuahua;
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
RUBÉN BURGOS-VARGAS
Servicio de Reumatología, Hospital General de México, Facultad de Medicina, Universidad Nacional Autónoma de México.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: r.burgos.vargas@gmail.com
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
  • eLetters
PreviousNext
Loading

To the Editor:

We thank The Journal for the opportunity to address some details in the editorial by Appel and Sieper1 about our recent paper “Bone Lineage Proteins in the Entheses of the Midfoot in Patients with Spondyloarthritis”2.

As Appel and Sieper stated1, we reported the lack of inflammatory lesions in our set of tissue samples2. Yet in contrast to their interpretation, our findings did not result from the study of patients in the advanced stage of what we have called “ankylosing tarsitis”, but for reasons that were already mentioned in the paper.

Figure 1 does not represent the population included in the study; it illustrates only the most advanced stage of ankylosing tarsitis2. In fact, there were only 3 patients (16.6%) classified as Grade 4 according to the SpondyloArthropathies Tarsal Radiographic Index (SpA-TRI)3.

The SpA-TRI is an instrument designed for the evaluation of the radiographic changes that occur in the tarsus and adjacent areas of the foot in patients with SpA. The involvement of the foot, particularly the tarsus, is a prominent feature in Mexican children and adolescents with SpA — and certainly in other ethnicities — that resembles the structural changes of the spine in patients with ankylosing spondylitis (AS). The characteristics of SpA-TRI grading and the percentage of patients included in each of them in our study are shown in Table 1. We regret that this information was not included in the original publication.

View this table:
  • View inline
  • View popup
Table 1.

Grading, description, and patients in each category of SpA-TRI.

We decided to include the figure with a radiograph of an ankylosing tarsitis graded 4 to better show the reader a not very well-known clinical entity. It is also intended to show the aggressiveness of the process, and moreover the realistic rather than metaphoric name — ankylosing tarsitis — that we gave to this condition around the mid-80s4,5, and to show the parallels with AS in regard to the severity of bone proliferation that can be established. Indeed, Figure 1 and the related text appear in the second paragraph of “Introduction” to deal with the concept and definition of ankylosing tarsitis.

We indeed agree with Appel and Sieper’s1 idea that acute inflammatory lesions are not necessarily expected in this advanced stage, which probably refers to Grade 4 ankylosing tarsitis. Yet again they failed to recognize that not all our patients had longterm advanced disease and that the lack of inflammation we found in our tissue samples was also described in early inflammatory cases. Interestingly, they referred to Gong, et al’s6 study of patients with short-term AS (3 to 4 yrs). Certainly, we included patients with active disease, defined by pressure tenderness and sometimes swelling in various areas of the foot, raised serum C-reactive protein, and in some cases inflammation on magnetic resonance of the feet. We also showed active joints and entheses counts, as well as the Bath Ankylosing Spondylitis Disease Activity Index data to confirm the inflammatory stage of the disease. Regarding disease duration, Table 1 of the paper shows 2.39 ± 0.79 years in the group already having bone proliferation.

In agreement with Appel and Sieper1, the lack of inflammatory infiltrates in advanced stage of the disease is more than expected. In contrast, the absence of inflammatory cells in areas close to proliferative changes should bring into question the role of inflammation in bone ankylosis and syndesmophyte formation. Cortical whiskering seems to be an early finding in peripheral SpA (including reactive and psoriatic arthritis), associated with entheseal cells and fibroblasts shifted toward bone lineage, as shown by the abnormal expression of bone-specific proteins. Despite some limitations, our findings suggest that bone proliferation in ankylosing tarsitis might require not the effect of activated immune response cells, but other factors, including mechanical stress, hormonal differentiation and maturation, and growth factors.

REFERENCES

  1. 1.↵
    1. Appel H,
    2. Sieper J
    . Analysis of bone samples from patients with spondyloarthritides-identifying causes of new bone formation in axial spondyloarthritis. J Rheumatol 2015;42:561–3.
    OpenUrlFREE Full Text
  2. 2.↵
    1. Pacheco-Tena C,
    2. Pérez-Tamayo R,
    3. Pineda C,
    4. González-Chávez SA,
    5. Quiñonez-Flores C,
    6. Vitelly A,
    7. et al.
    Bone lineage proteins in the entheses of the midfoot in patients with spondyloarthritis. J Rheumatol 2015;42:630–7.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Pacheco-Tena C,
    2. Londoño JD,
    3. Cazarín-Barrientos J,
    4. Martínez A,
    5. Vázquez-Mellado J,
    6. Moctezuma JF,
    7. et al.
    Development of a radiographic index to assess the tarsal involvement in patients with spondyloarthropathies. Ann Rheum Dis 2002;61:330–4.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    1. Burgos-Vargas R,
    2. Madariaga-Ceceña MA,
    3. Katona-Salgo G
    . [Juvenile ankylosing spondylitis: clinical characteristics in 41 patients]. [Article in Spanish] Bol Med Hosp Infant Mex 1985;42:523–30.
    OpenUrlPubMed
  5. 5.↵
    1. Burgos-Vargas R,
    2. Granados Arriola J
    . Ankylosing spondylitis and related diseases in the Mexican mestizo. In: Khan MA, ed. Seronegative spondyloarthropathies. Philadelphia: Hanley & Belfus; 1990:665–78.
  6. 6.↵
    1. Gong Y,
    2. Zheng N,
    3. Chen SB,
    4. Xiao ZY,
    5. Wu MY,
    6. Liu Y,
    7. et al.
    Ten years’ experience with needle biopsy in the early diagnosis of sacroiliitis. Arthritis Rheum 2012;64:1399-406.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

The Journal of Rheumatology
Vol. 42, Issue 11
1 Nov 2015
  • Table of Contents
  • Table of Contents (PDF)
  • Index by Author
  • Editorial Board (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about The Journal of Rheumatology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Bone Proliferation in Ankylosing Tarsitis Might Involve Mechanical Stress, and Hormonal and Growth Factors
(Your Name) has forwarded a page to you from The Journal of Rheumatology
(Your Name) thought you would like to see this page from the The Journal of Rheumatology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Bone Proliferation in Ankylosing Tarsitis Might Involve Mechanical Stress, and Hormonal and Growth Factors
CÉSAR PACHECO-TENA, SUSANA A. GONZÁLEZ-CHÁVEZ, CELIA QUIÑONEZ-FLORES, RUBÉN BURGOS-VARGAS
The Journal of Rheumatology Nov 2015, 42 (11) 2210; DOI: 10.3899/jrheum.150475

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

 Request Permissions

Share
Bone Proliferation in Ankylosing Tarsitis Might Involve Mechanical Stress, and Hormonal and Growth Factors
CÉSAR PACHECO-TENA, SUSANA A. GONZÁLEZ-CHÁVEZ, CELIA QUIÑONEZ-FLORES, RUBÉN BURGOS-VARGAS
The Journal of Rheumatology Nov 2015, 42 (11) 2210; DOI: 10.3899/jrheum.150475
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Bookmark this article

Jump to section

  • Article
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
  • eLetters

Related Articles

Cited By...

More in this TOC Section

  • Dr. Kitajima et al reply
  • Dr. Putman et al reply
  • Drs. Chung and McMahan reply
Show more Correspondence

Similar Articles

Content

  • First Release
  • Current
  • Archives
  • Collections
  • Audiovisual Rheum
  • COVID-19 and Rheumatology

Resources

  • Guide for Authors
  • Submit Manuscript
  • Author Payment
  • Reviewers
  • Advertisers
  • Classified Ads
  • Reprints and Translations
  • Permissions
  • Meetings
  • FAQ
  • Policies

Subscribers

  • Subscription Information
  • Purchase Subscription
  • Your Account
  • Terms and Conditions

More

  • About Us
  • Contact Us
  • My Alerts
  • My Folders
  • Privacy/GDPR Policy
  • RSS Feeds
The Journal of Rheumatology
The content of this site is intended for health care professionals.
Copyright © 2022 by The Journal of Rheumatology Publishing Co. Ltd.
Print ISSN: 0315-162X; Online ISSN: 1499-2752
Powered by HighWire