Role of inflammation in tendinopathy
In recent literature, especially over the last 3-6 years, there is an increasing support for the presence of an inflammatory component to tendinopathy, as more robust definitions of inflammation have begun to be used.
If this continues to be confirmed, then mechanisms of tendon pathology and therapeutic options can be studied and tested with greater objectivity. Additionally, new preventative measures can be taken to limit the progression and tendinopathy.
Historically, there have been theoretical shifts in the role of inflammation in tendinopathy. Earlier studies defended the presence of an inflammatory component in non-acute diseased tendon pathology; later, the failure of anti-inflammatory therapy and histological data caused a shift towards a degenerative mechanism to tendinopathy.
A total of 113 studies were included in this review. Studies were classified according to their conclusions on whether there was a multifactorial, degenerative, inflammatory, or other major mechanism of tendinopathy.
The adoption or rejection of an inflammatory component to tendinopathy was found to be strongly associated with the definition used. Studies that only analyzed the presence of neutrophils were significantly more likely to reject an inflammatory cause, while recent studies analyzing a greater variety of cell types and signaling molecules tended to defend the role of inflammation in tendinopathy.
Merely considering a degenerative pathogenesis based on limited analyses may thus be an oversimplification of tendon pathogenesis, which seems to be characterized by a multitude of factors such as ageing, overuse, genetics and also inflammation. This oversimplification may also overlook the differences between acute and chronic inflammation.
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Expert opinion by José Pedro Correia
This is a very interesting review not only in terms of its findings, but also for showing us how quality evidence leads to changes in the prevailing theories over time. As this is an open-access article, a full in-detail read is highly recommended.
The fact that the most robust and recent evidence indicates that the role of inflammation in tendinopathy should not be discarded, should alert everyone involved in managing these conditions to direct their evaluation and treatment accordingly. Prevention and monitoring strategies should also be influenced by this latest shift.
> From: Mosca et al., BMJ Open Sport Exerc Med 4 (2018) e000332 (Epub ahead of print). All rights reserved to BMJ Publishing Group Ltd. Click here for the online summary.