Table of Contents
Introduction
Enthesitis is the painful inflammation of an enthesis, the site where ligaments or tendons attach to bone. Common in spondyloarthritis (e.g., psoriatic arthritis), it typically causes pain, stiffness, and tenderness, often in the heels, elbows, or hips. Treatment includes NSAIDs, biologics, rest, and physical therapy to manage symptoms and prevent potential joint damage.
Symptoms of Enthesitis
- Pain: Often described as severe or burning, specifically at tendon insertion sites, such as the Achilles tendon or bottom of the foot.
- Stiffness: Increased difficulty moving the affected joint.
- Tenderness: Sensitivity to touch.
- Swelling: While not always present, swelling can occur in the soft tissue surrounding the site.
- Impact on Mobility: Chronic cases can limit mobility and cause damage to adjacent bone and joints.
Causes and Risk Factors
- Inflammatory Arthritis: Most frequently associated with psoriatic arthritis (PsA), ankylosing spondylitis (AS), and other forms of spondyloarthritis (SpA).
- Physical Stress/Overuse: Repeated physical activity causing strain at the attachment site.
- Immune System Dysfunction: Pro-inflammatory cytokine activity (specifically IL-17 and TNF-
) is a major contributor to this inflammatory cascade.
Treatment Approaches
- Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line of treatment. For more chronic cases, biologics targeting TNF or IL-17 are often used.
- Physical Interventions: Rest, immobilization, and gentle stretching.
- Injections: Local corticosteroid injections, though used with caution near tendons.
- Lifestyle Changes: Maintaining a healthy weight to reduce pressure on joints.
CreakyJoints
Common Sites
Enthesitis can occur throughout the body, with more than 100 potential locations. Common sites include:
- Achilles tendon (heel)
- Plantar fascia (bottom of the foot)
- Elbows (epicondylitis)
- Hips
- Patellar tendon (knee)
