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Secondly, the high frequency of enthesitis in AS shoulders with multiple entheseal involvement in shoulder compared with controls, and the bilateral aspect of enthesitis in AS shoulders.
In addition, entheseal involvement was multiple in 21 of 76 AS shoulders and in 14 patients with AS (36.8%), however, there was not multiple entheseal involvement in control shoulders.
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Furthermore, prominent entheseal involvement on MRI is seen in only a minority of patients.
In the group of patients with AS, 23/38 patients had previously known entheseal involvement.
Finally, imaging studies have highlighted entheseal involvement in psoriatic arthritis, and it is possible that entheseal-derived antigens may trigger an immune response that is critically involved in disease pathogenesis.
Whether a similar model applies to human disease, or even a proportion thereof where there is prominent entheseal involvement (<30% of PsA cases), has yet to be demonstrated.
We and others have demonstrated that this model shares striking features with human spondyloarthritis, in particular entheseal involvement, progressive ankylosis but also dactylitis.
Anatomical studies have shown that the enthesis is continuous with the joint structure [ 14] and that it also merges into the nail bed [ 16], allowing for the development of concepts that link entheseal involvement with prominent features of PsA, both synovitis and nail dystrophic change.
In a cross-sectional study involving 114 cases with multiple organ involvement, lymphadenopathy was found in 41%% of patients [2].
Multiple cytokines and chemokines are involved in the pathogenesis of DME, with multiple cellular involvement affecting the neurovascular unit.
Most patients (80%) showed multiple region involvement.
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