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Most of the time I talk about recognition of Rheumatological diseases that have developed and require onward referral; it has become my schtick. Reasonably many people ask me about people they work with who have already been diagnosed or don’t meet criteria for onward referral but have risk factor comorbidities.

Here I will take you through these two scenarios and the adaptations and considerations we need to employ when we see people with existing autoinflammatory disorders.

“This Isn’t A Problem” - You, The Reader

“If the person doesn’t meet a threshold for onward referral to Rheumatology then there is no problem - they present with tendon-related issues and we manage them” is what someone would say if they were naive to the ways auto-inflammatory conditions, particularly spondyloarthritis, affect tendons.

Let me spell out some problems:

Spondyloarthritis (particularly peripheral or PSpA) can be triggered by tendon load spikes just like normal tendinopathy.

Spondyloarthritis particularly affects high load tendon entheses such as the plantarfascia, Achilles, patella and lateral hip, just like normal tendinopathy. [1]

PSpA affecting the entheses of the high load tendons presents clinically almost indistinguishably from normal tendinopathy.

Tendon research almost exclusively removes people with spondyloarthritis from their cohorts to reduce confounding variables.

I could actually go further but I think I risk losing some of you to boredom. The point is made and these issues aren’t the crucial component of what I want to write about in this particular piece.

Managing Tendons On A Background Of Auto-Inflammatory Pathology

There are two main scenarios we need to consider and although they are similar in approach, the outcomes are slightly different so we will look at them in detail. These are:

* Person with DIAGNOSED spondyloarthritis.

* Person with inflammatory comorbidity that increases risk of DEVELOPING spondyloarthritis - namely psoriasis, ulcerative colitis, Crohn’s Disease, uveitis/iritis.