Question: What Is Enthesitis?
If you have seen the words entheses, enthesitis or enthesopathy in your x-ray or medical reports, you may have been unclear about their meaning.
- What is enthesitis?
- What are the symptoms?
- How is enthesitis treated?
- Is enthesitis more common with certain types of arthritis?
What Is Enthesopathy?
Enthesopathy is a condition that affects the entheses (e.g., inflammation of the entheses). The entheses are sites of tendinous or ligamentous attachment to the bone. Enthesopathy may be due to an inflammatory condition, such as psoriatic arthritis, or a condition due to injury or overload, such as plantar fasciitis.
Conditions Associated With Enthesitis
Conditions associated with enthesitis include:
- Achilles tendinitis
- reactive arthritis
- rheumatoid arthritis
- diffuse idiopathic skeletal hyperostosis (DISH)
Symptoms Associated With Enthesitis
Symptoms include pain and often swelling. In addition to pain and swelling of the heel, other commonly affected areas include the toes and fingers. Toes and fingers can look like a sausage due to swelling at the entheses. With enthesitis, the elbow, pelvis and chest wall may also have pain or swelling.
Treatment of Enthesitis
Treatment of enthesitis is based on the underlying condition. For example, if enthesitis is due to an inflammatory condition, such as psoriatic arthritis, treatment may include:
- nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g. ibuprofen, naproxen)
- TNF blockers (which include Enbrel, Remicade, and Humira)
For plantar fasciitis unrelated to an inflammatory condition, heel inserts and NSAIDs are used.
Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle of Anti-TNF Blockers and co-author of Natural Arthritis Treatment.