If you have seen the words entheses, enthesitis, or enthesopathy in your X-ray or medical reports, the terminology may have been unfamiliar to you. Let’s look at the meaning and also how it relates to varioustypes of arthritisand rheumatic diseases.
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Symptoms
Enthesitis is typically associated with pain, stiffness, and tenderness at the insertion site, sometimes without much swelling. However, where there is involvement of the large insertions of lower limbs, swelling can be significant and prominent. If swelling is absent, enthesitis can be difficult to recognize or suspect during a physical examination.
Enthesitis is common at the following sites:
Conditions Associated With Enthesitis
Ankylosing spondylitis is an inflammatory condition that is most prevalent in men. The inflammation of ankylosing spondylitis affects the vertebrae and causes them to fuse. Chronic enthesitis of the tendons and ligaments of the vertebrae is the first step in the eventual fusion of vertebrae, which is the main feature of ankylosing spondylitis. People with ankylosing spondylitis can also experience enthesitis of thecostochondral joints, or joints of the ribs.
Other conditions associated with enthesitis include Achilles tendinitis,rheumatoid arthritis,osteoarthritis, anddiffuse idiopathic skeletal hyperostosis(DISH). It may be degenerative enthesopathy that develops with osteoarthritis. The degenerative changes that occur with wear-and-tear osteoarthritis also affect the fibrocartilages.
Imaging for Diagnosis
Imaging can help diagnose enthesitis, but the imaging modality utilized depends on whether the axial or peripheral skeleton is affected. MRI is used for the axial skeleton. Ultrasound is preferred for the peripheral skeleton. MRI would again be preferable for any insertions that are inaccessible.
Treatment
Treatment of enthesitis is based on the underlying condition. For example, if enthesitis is due to an inflammatory condition, treatment usually focuses on treating the inflammatory polyarthritis. Treatment, in such cases, may include:
Depending on which areas are involved,local corticosteroid injectionsmay be used if oral medications are inadequate. However, a healthcare provider would almost never use these injections for Achilles tendinitis or into the patella; this could lead to rupture.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Isaacs J.Oxford textbook of rheumatology. Oxford, UK: OUP Oxford.Creakyjoints.org.What is enthesitis? the painful arthritis symptom you should know about.Kataria RK, Brent LH.Spondyloarthropathies.Am Fam Physician. 69(12):2853-60.Sufka P.Reactive arthritis. American College of Rheumatology.Holliman K.How is a person affected?. Spondylitis Association of America.Baraliakos X, Conaghan PG, D’Agostino MA, Maksymowych W, Naredo E, Ostergaard M, et al.Imaging in rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and osteoarthritis: An international viewpoint on the current knowledge and future research priorities.Eur J Rheumatol, 6(1):38-47.Aggarwal A, Sawhney S.Pediatric rheumatology: A clinical viewpoint. New York, NY: Springer Publishing.Additional ReadingBruyn, George AW, MD. PhD.Musculoskeletal Ultrasonography - Clinical Applications. Up-To-Date.Kehl, AS, MD. et al.Enthesitis. Arthritis & Rheumatology. 68(2): 312-322.McGonagle D. and Benjamin, M.Entheses, Enthesitis, and Enthesopathy. Arthritis Research Campaign. Topical Reviews.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Isaacs J.Oxford textbook of rheumatology. Oxford, UK: OUP Oxford.Creakyjoints.org.What is enthesitis? the painful arthritis symptom you should know about.Kataria RK, Brent LH.Spondyloarthropathies.Am Fam Physician. 69(12):2853-60.Sufka P.Reactive arthritis. American College of Rheumatology.Holliman K.How is a person affected?. Spondylitis Association of America.Baraliakos X, Conaghan PG, D’Agostino MA, Maksymowych W, Naredo E, Ostergaard M, et al.Imaging in rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and osteoarthritis: An international viewpoint on the current knowledge and future research priorities.Eur J Rheumatol, 6(1):38-47.Aggarwal A, Sawhney S.Pediatric rheumatology: A clinical viewpoint. New York, NY: Springer Publishing.Additional ReadingBruyn, George AW, MD. PhD.Musculoskeletal Ultrasonography - Clinical Applications. Up-To-Date.Kehl, AS, MD. et al.Enthesitis. Arthritis & Rheumatology. 68(2): 312-322.McGonagle D. and Benjamin, M.Entheses, Enthesitis, and Enthesopathy. Arthritis Research Campaign. Topical Reviews.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Isaacs J.Oxford textbook of rheumatology. Oxford, UK: OUP Oxford.Creakyjoints.org.What is enthesitis? the painful arthritis symptom you should know about.Kataria RK, Brent LH.Spondyloarthropathies.Am Fam Physician. 69(12):2853-60.Sufka P.Reactive arthritis. American College of Rheumatology.Holliman K.How is a person affected?. Spondylitis Association of America.Baraliakos X, Conaghan PG, D’Agostino MA, Maksymowych W, Naredo E, Ostergaard M, et al.Imaging in rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and osteoarthritis: An international viewpoint on the current knowledge and future research priorities.Eur J Rheumatol, 6(1):38-47.Aggarwal A, Sawhney S.Pediatric rheumatology: A clinical viewpoint. New York, NY: Springer Publishing.
Isaacs J.Oxford textbook of rheumatology. Oxford, UK: OUP Oxford.
Creakyjoints.org.What is enthesitis? the painful arthritis symptom you should know about.
Kataria RK, Brent LH.Spondyloarthropathies.Am Fam Physician. 69(12):2853-60.
Sufka P.Reactive arthritis. American College of Rheumatology.
Holliman K.How is a person affected?. Spondylitis Association of America.
Baraliakos X, Conaghan PG, D’Agostino MA, Maksymowych W, Naredo E, Ostergaard M, et al.Imaging in rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and osteoarthritis: An international viewpoint on the current knowledge and future research priorities.Eur J Rheumatol, 6(1):38-47.
Aggarwal A, Sawhney S.Pediatric rheumatology: A clinical viewpoint. New York, NY: Springer Publishing.
Bruyn, George AW, MD. PhD.Musculoskeletal Ultrasonography - Clinical Applications. Up-To-Date.Kehl, AS, MD. et al.Enthesitis. Arthritis & Rheumatology. 68(2): 312-322.McGonagle D. and Benjamin, M.Entheses, Enthesitis, and Enthesopathy. Arthritis Research Campaign. Topical Reviews.
Bruyn, George AW, MD. PhD.Musculoskeletal Ultrasonography - Clinical Applications. Up-To-Date.
Kehl, AS, MD. et al.Enthesitis. Arthritis & Rheumatology. 68(2): 312-322.
McGonagle D. and Benjamin, M.Entheses, Enthesitis, and Enthesopathy. Arthritis Research Campaign. Topical Reviews.
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