Enthesopathy: a symptom seldom recognized by pediatricians

OBJECTIVE: The disease in the entheses, which are sites of attachment of tendons, ligaments, fascias or joint capsules to bone, may be noted clinically by the onset of tenderness or pain associated to digitopression in certain points. This revision article aims to draw the attention of pediatricians to the enthesopathies or enthesitis (inflammatory disease of these structures) in childhood and adolescence. METHODS: The study reviews concepts about the structure of the enthesis and the clinical, laboratorial and radiological features concerning enthesopathy, as well as differential diagnosis and therapeutic measures. Articles and texts concerning the theme were obtained based on a research in Medline (available data since 1966) and Lilacs (available data since 1981) database, as well as in Pediatric Rheumatology textbooks published after 1990. RESULTS: Enthesopathy in children and adolescents appears more often in the limbs and seems to be associated to the development of spondyloarthropathies, occurring less commonly in other inflammatory diseases or even noninflammatory conditions. CONCLUSIONS: The identification of enthesopathies is important to the early diagnosis of children and adolescents in risk of developing spondyloarthropathies, so that they may be included early in an adequate program of physical and drug therapies.