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the occipital enthesophyte &#40;OE&#41; is present in 41&#37; of all adults under the age of 30 years&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; OE has not been documented in inflammatory rheumatic diseases&#59; therefore&#44; our aim was to determine its prevalence in PsA&#44; SpA&#44; and rheumatoid arthritis &#40;RA&#41; and to compare it with patients with mechanical neck pain &#40;MNP&#41;&#46; We designed a retrospective descriptive study of the plain cervical X-rays in lateral projection of individuals over 18 years of age who attended the rheumatology department of a university hospital between July 2022 and January 2023&#59; a total of 30 patients per group &#40;120 in total&#41; were studied&#46; The reason for requesting the radiograph was neck pain in the MNP group &#40;excluding traffic accidents and neck surgery&#41; and RA&#44; and as part of the diagnostic protocol in the PsA and SpA groups&#46; The following variables were obtained&#58; sex&#44; age at the time the X-ray was performed&#44; OE &#40;yes&#47;no&#41; assessed by a rheumatologist with 25 years of experience and by a fourth-year rheumatology resident&#46; The results are presented descriptively&#59; Cohen&#8217;s Kappa coefficient was calculated to quantify the degree of agreement between the two rheumatologists&#59; sex and prevalence were compared using the &#967;<span class="elsevierStyleSup">2</span> test&#44; applying the Yates correction&#44; and ANOVA was used for mean age&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Seventy-eight per cent &#40;78&#37;&#41; were female and the mean age of the sample was 58&#46;5&#8239;&#177;&#8239;15 years&#46; The four groups were homogeneous in terms of sex and age&#44; and stratified analysis failed to reveal any difference &#40;p&#8239;&#61;&#8239;0&#46;2 and p&#8239;&#61;&#8239;0&#46;06&#44; respectively&#41;&#44; only a tendency toward greater presence in the elderly in the MNP group&#46; Fifty-one per cent &#40;51&#37;&#41; had OE&#44; 23&#37; in the MNP group and 60&#37; in inflammatory diseases &#40;70&#37; SpA&#44; 70&#37; AP&#44; and 40&#37; RA&#41;&#44; with OE being statistically significant in inflammatory rheumatic diseases &#40;p&#8239;&#60;&#8239;0&#46;001&#41;&#46; Substantial agreement was reached overall &#40;89&#37;&#41; and almost perfect agreement in SpA and PsA &#40;97&#37;&#41;&#46; To describe them macroscopically&#44; different OE morphologies were seen to be thicker in the SpA and PsA groups and thinner in the RA group &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In psoriatic patients the burden of bone erosions is not significantly greater than in healthy controls&#44; whereas the differences in enthesophytes are far more pronounced&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The prevalence of asymptomatic enthesopathy with Doppler signal on ultrasound was significantly higher in psoriatic patients &#40;77&#37;&#41; than in controls<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and has been proven to be specific to peripheral enthesitis in SpA&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Given that this was an exploratory study&#44; there are several limitations&#58; we did not correlate this enthesopathy with pain&#44; type of psoriasis&#44; HLA-B27 genetic predisposition&#44; physical activity&#44; or BMI&#46; consequently&#44; we will assess this in future studies using other imaging tests to determine whether it might be helpful in the early diagnosis of psoriasis patients without PsA7 or with nascent PsA and negative SpA-B27&#44; and whether it might be a predictive factor for developing a more severe form of the disease&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">This research has not received any specific support from public sector agencies&#44; 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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">The authors would like to acknowledge Dr Jes&#250;s Sanz for having noted this enthesophyte and proposing for having noticed this enthesophyte and proposing that it be designated&#44; as a secondary term&#44; Sanz&#39;s sign&#46;</p>"
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Letter to the Editor
Available online 29 October 2024
Prevalence of occipital enthesophyte in non-inflammatory and inflammatory rheumatic diseases
Prevalencia del entesofito occipital en enfermedades reumáticas inflamatorias y no inflamatorias
Natalia de la Torre Rubio
Corresponding author
ndltr.md@icloud.com

Corresponding author.
, Jose Campos Esteban, José Luis Andréu Sánchez, Jesús Sanz Sanz
Servicio de Reumatología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain

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