Tendon and ligament disorders in the practice of a rheumatologist and traumatologist-orthopedist. Descriptive review

Tendon and ligament involvement is a common rheumatic pathology and one of the most frequent causes of chronic musculoskeletal pain, accompanied by significant functional impairment and reduced quality of life. These disorders may be localized and regarded as an independent nosological entity (rotator cuff impingement syndrome, lateral epicondylitis, patellar tendonitis, etc.) or represent a manifestation of a systemic immune-mediated inflammatory rheumatic disease (most typically in spondyloarthritis). The pathogenesis of tendino-, ligamento-, and enthesopathy is determined by local destruction of collagen fibers, a short-term inflammatory reaction, and degenerative changes (fibrosis, neoangiogenesis, axonal sprouting, heterotopic ossification) that substantially worsen biomechanics and increase the risk of recurrent injury. Pain chronicity in this disorders is associated with sensitization of nociceptors caused by hyperproduction of neurotrophic factors. Risk factors for tendino- and ligamentopathy include trauma, type 2 diabetes mellitus, cardiovascular pathology, and smoking. Treatment of tendon and ligament disorders is complex and includes pharmacological and non-pharmacological approaches. The former includes nonsteroidal antiinflammatory drugs, local injection therapy with glucocorticoids, hyaluronic acid, and platelet-rich plasma. In some cases, muscle relaxants, antidepressants, anticonvulsants, slow-acting symptomatic agents, and botulinum toxin preparations are used. A new direction in the comprehensive therapy of tendino- and ligamentopathies is the use of specialized dietary supplements with analgesic, anti-inflammatory, and reparative effects.