{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T12:19:53Z","timestamp":1767097193228,"version":"3.48.0"},"reference-count":20,"publisher":"Medical Communications Sp. z.o.o.","issue":"102","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Ultrason"],"abstract":"<jats:p>Aim: Ehlers-Danlos syndromes (EDS) are connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. When spondyloarthritis (SpA), an inflammatory arthritis, co-occurs with EDS, overlapping symptoms of joint pain may arise, making diagnosis and management challenging. The aim of this study was to investigate enthesopathic differences in the patellar tendon between patients with EDS and those with co-occurring SpA. Material and methods: Twenty-three participants with EDS and co-occurring SpA (SpA + EDS) and 14 participants with EDS without SpA (EDS-only) underwent ultrasound examination. Assessments were conducted at the inferior patellar pole, mid-patellar tendon, and tibial tuberosity to evaluate enthesopathic changes, including calcifications, enthesophytes, and tendon thickness. Statistical analyses were performed to identify significant differences between groups. Results: The most common tendon pathology was hypoechoic change at the level proximal to the tibial tuberosity and the inferior pole of the patella. Compared with the EDS-only group, tendon thickness at the patellar pole was significantly greater in the SpA + EDS group (p = 0.002). Conclusions: The presence of increased patellar tendon thickness in the SpA + EDS group suggests structural adaptations consistent with enthesopathic change in the context of coexisting inflammatory and connective tissue disorders. These findings highlight the potential role of ultrasound in the evaluation of tendon alterations in hypermobile patients, underscoring the need for longitudinal, multimodal studies to clarify the clinical relevance of these sonographic differences.<\/jats:p>","DOI":"10.15557\/jou.2025.0029","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T12:15:01Z","timestamp":1767096901000},"source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound assessment of patellar enthesopathy in patients with Ehlers-Danlos syndrome with and without concomitant axial spondyloarthropathy"],"prefix":"10.15557","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3705-7927","authenticated-orcid":false,"given":"Tina","family":"Wang","sequence":"first","affiliation":[{"name":"Physical Medicine and Rehabilitation, Loma Linda University School of Medicine, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8259-0531","authenticated-orcid":false,"given":"Ana Mar\u00eda","family":"Serrano-Ardila","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, The American British Cowdray Medical Center, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-6549","authenticated-orcid":false,"given":"Carmelo","family":"Pirri","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Institute of Human Anatomy, University of Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6250","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"1. Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J et al.: The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet 2017; 175: 8\u201326. doi: 10.1002\/ajmg.c.31552.","DOI":"10.1002\/ajmg.c.31552"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"2. Rodgers KR, Gui J, Dinulos MBP, Chou RC: Ehlers-Danlos syndrome hypermobility type is associated with rheumatic diseases. Sci Rep 2017; 7: 39636. doi: 10.1038\/srep39636.","DOI":"10.1038\/srep39636"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"3. Donzella D, Bellis E, Iagnocco A: Ultrasound as a tool for the diagnosis of spondylarthritis in women. Reumatismo 2024; 76. doi: 10.4081\/reumatismo.2024.1767.","DOI":"10.4081\/reumatismo.2024.1767"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"4. McGonagle D, Marzo-Ortega H, O\u2019Connor P, Gibbon W, Hawkey P, Henshaw K, Emery P: Histological assessment of the early enthesitis lesion in spondyloarthropathy. Ann Rheum Dis 2002 Jun; 61: 534\u2013537. doi: 10.1136\/ard.61.6.534.","DOI":"10.1136\/ard.61.6.534"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"5. Wink F, Bruyn GA, Maas F, Griep EN, van der Veer E, Bootsma H et al.: Ultrasound evaluation of the entheses in daily clinical practice during tumor necrosis factor-\u03b1 blocking therapy in patients with ankylosing spondylitis. J Rheumatol 2017; 44: 587\u2013593. doi: 10.3899\/jrheum.160584.","DOI":"10.3899\/jrheum.160584"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"6. Matschke V, Jones JG, Lemmey AB, Maddison PJ, Thom JM: Patellar tendon properties and lower limb function in rheumatoid arthritis and ankylosing spondylitis versus healthy controls: a cross-sectional study. Scientific World Journal 2013; 2013: 514743. doi: 10.1155\/2013\/514743.","DOI":"10.1155\/2013\/514743"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"7. Balint PV, Terslev L, Aegerter P, Bruyn GAW, Chary-Valckenaere I, Gandjbakhch F et al.; OMERACT Ultrasound Task Force members. Reliability of a consensusbased ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis 2018; 77: 1730\u20131735. doi: 10.1136\/annrheumdis-2018-213609.","DOI":"10.1136\/annrheumdis-2018-213609"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"8. Palmer S, Denner E, Riglar M, Scannell H, Webb S, Young G: Quantitative measures of tissue mechanics to detect hypermobile Ehlers-Danlos syndrome and hypermobility syndrome disorders: a systematic review. Clin Rheumatol 2020; 39: 715\u2013725. doi: 10.1007\/s10067-020-04939-2.","DOI":"10.1007\/s10067-020-04939-2"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"9. Stern CM, Pepin MJ, Stoler JM, Kramer DE, Spencer SA, Stein CJ: Musculoskeletal conditions in a pediatric population with Ehlers-Danlos syndrome. J Pediatr 2017; 181: 261\u2013266. doi: 10.1016\/j.jpeds.2016.10.078.","DOI":"10.1016\/j.jpeds.2016.10.078"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"10. Spadaro A, Iagnocco A, Perrotta FM, Modesti M, Scarno A, Valesini G: Clinical and ultrasonography assessment of peripheral enthesitis in ankylosing spondylitis. Rheumatology (Oxford) 2011; 50: 2080\u20132086. doi: 10.1093\/rheumatology\/ker284.","DOI":"10.1093\/rheumatology\/ker284"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"11. de Miguel E, Cobo T, Mu\u00f1oz-Fern\u00e1ndez S, Naredo E, Us\u00f3n J, Acebes JC et al.: Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis 2009; 68: 169\u2013174. doi: 10.1136\/ard.2007.084251.","DOI":"10.1136\/ard.2007.084251"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"12. Ishida SN, Furtado RNV, Rosenfeld A, Proglhof JEP, Estrela GBQ, Natour J: Ultrasound of entheses in ankylosing spondylitis patients: The importance of the calcaneal and quadriceps entheses for differentiating patients from healthy individuals. Clinics (Sao Paulo) 2019; 74: e727. doi: 10.6061\/clinics\/2019\/e727.","DOI":"10.6061\/clinics\/2019\/e727"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"13. Benjamin M, McGonagle D: The enthesis organ concept and its relevance to the spondyloarthropathies. Adv Exp Med Biol 2009; 649: 57\u201370. doi: 10.1007\/978-1-4419-0298-6_4.","DOI":"10.1007\/978-1-4419-0298-6_4"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"14. Jacques P, Lambrecht S, Verheugen E, Pauwels E, Kollias G, Armaka M, et al. Proof of concept: enthesitis and new bone formation in spondyloarthritis are driven by mechanical strain and stromal cells. Ann Rheum Dis 2014; 73: 437\u2013445. doi: 10.1136\/annrheumdis-2013-203643.","DOI":"10.1136\/annrheumdis-2013-203643"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"15. Robbins SM, Wolfe R, Chang YY, Lavoie M, Preston E, Hazel EM: Inter-segmental coordination amplitude and variability differences during gait in patients with Ehlers-Danlos syndrome and healthy adults. Clin Biomech (Bristol) 2022; 94: 105515. doi: 10.1016\/j.clinbiomech.2021.105515.","DOI":"10.1016\/j.clinbiomech.2021.105515"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"16. Jensen JK, Nygaard RH, Svensson RB, Hove HD, Magnusson SP, Kj\u00e6r M et al. Biomechanical properties of the patellar tendon in children with heritable connective tissue disorders. Eur J Appl Physiol 2018; 118: 1301\u20131307. doi: 10.1007\/s00421-018-3862-7","DOI":"10.1007\/s00421-018-3862-7"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"17. Chiarelli N, Zoppi N, Ritelli M, Venturini M, Capitanio D, Gelfi C, Colombi M: Biological insights in the pathogenesis of hypermobile Ehlers-Danlos syndrome from proteome profiling of patients\u2019 dermal myofibroblasts. Biochim Biophys Acta Mol Basis Dis 2021; 1867: 166051. doi: 10.1016\/j.bbadis.2020.166051.","DOI":"10.1016\/j.bbadis.2020.166051"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"18. Chen W, Deng Y, Zhang J, Tang K: Uniaxial repetitive mechanical overloading induces influx of extracellular calcium and cytoskeleton disruption in human tenocytes. Cell Tissue Res 2015; 359: 577\u2013587. doi: 10.1007\/s00441-014-2018-2.","DOI":"10.1007\/s00441-014-2018-2"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"19. Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD et al.: Tendinopathy. Nat Rev Dis Primers. 2021 Jan 7;7(1):1. doi: 10.1038\/s41572-020-00234-1. Erratum in: Nat Rev Dis Primers. 2021 Feb 3;7(1):10. doi: 10.1038\/s41572-021-00251-8.","DOI":"10.1038\/s41572-021-00251-8"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"20. Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A: A framework for the classification of joint hypermobility and related conditions. Am J Med Genet 2017; 175: 148\u2013157. doi: 10.1002\/ajmg.c.31539.","DOI":"10.1002\/ajmg.c.31539"}],"container-title":["Journal of Ultrasonography"],"original-title":[],"deposited":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T12:15:06Z","timestamp":1767096906000},"score":1,"resource":{"primary":{"URL":"https:\/\/jultrason.pl\/index.php\/issues\/volume-25-no-102\/ultrasound-assessment-of-patellar-enthesopathy-in-patients-with-ehlers-danlos-syndrome-with-and-without-concomitant-axial-spondyloarthropathy"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":20,"journal-issue":{"issue":"102","published-online":{"date-parts":[[2025,9,30]]}},"URL":"https:\/\/doi.org\/10.15557\/jou.2025.0029","relation":{},"ISSN":["2084-8404","2451-070X"],"issn-type":[{"value":"2084-8404","type":"print"},{"value":"2451-070X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,30]]}}}