What Is Enthesopathy?
Tendons are the tissues that attach your muscles to your bones. Ligaments are what attach your bones to one another. The place where a tendon or ligament meets your bone is called an enthesis.
Enthesopathy is a broad term for conditions that affect these connection points. Enthesitis is when they get inflamed and become painful because of injury, overuse, or disease.
Enthesitis is common in some forms of arthritis, including psoriatic arthritis and ankylosing spondylitis. It also can happen in some children with juvenile idiopathic arthritis (also known as juvenile rheumatoid arthritis).
Types of Enthesopathies
There are many types of enthesopathies. Some of the most common are:
- Ankylosing spondylitis: inflammation (pain and swelling) in your spine, causing stiffness and pain
- Plantar fasciitis, affecting the connective tissue in the arch of your foot
- Achilles tendinitis, affecting the tendon in the back of your leg connecting your calf to your heel
- Rotator cuff syndrome in your shoulder
- Enthesopathy of elbow region
- Enthesopathy of hip region
- Enthesopathy of knee
- Enthesopathy of pelvis
- Enthesopathy of the heel
Enthesopathy Symptoms
Common spots for enthesitis are around your heel, knee, hip, toe, elbow, backbone, and the bottom of your foot. The inflammation can lead to pain and stiffness, especially when you're moving. You also might notice swelling around those areas.
Soreness at the back of your heel caused by enthesitis is sometimes called Achilles tendinitis or plantar fasciitis pain at the bottom of your foot. This pain can make it hard for you to run or climb stairs.
Over time, enthesitis can lead to:
- Calcification or ossification: Inflammation of the entheses can cause new bone tissue to form. That new bone tissue gets in the way of normal movement and function -- like a bone spur on your heel.
- Fibrosis: Tissues in the affected area become ropey.
Enthesopathy Causes
There are a few causes for enthesopathies:
Overuse. Overuse enthesopathies are usually related to repetitive motions --- doing the same thing over and over again, damaging a joint or other part of your body. Also called mechanical stress-related enthesopathies, they can happen from playing certain kinds of sports, like tennis, or doing repetitive tasks at work, for example.
Inflammation in your body. Inflammatory enthesopathies are often caused by diseases that cause inflammation in your body, like psoriatic arthritis and spondyloarthropathies.
Trauma to the area. An impact or injury to the joint can cause enthesopathy.
Genetics. Some genes passed down through your family can cause you to have a higher risk of certain types of injuries, like those that affect the Achilles tendon.
Enthesopathy Diagnosis
Enthesitis is hard to diagnose. Your doctor will give you a physical exam, check for swelling, and see if the area hurts when pressed. They’ll ask you questions about when the pain is worst and what activities make it hurt more.
Your doctor might order blood tests like a complete blood count (CBC) or other blood tests that look for high levels of specific inflammation markers. Imaging tests are usually used so your doctor can get a good view of your joints. The most common imaging tests for this are X-rays to look at the bones and ultrasounds or magnetic resonance imaging (MRI) to see the soft tissue around the bones.
Enthesopathy Treatment
There’s no specific treatment for enthesopathy, but there are treatments to help manage the conditions that lead to it. Your doctor has to determine why you have enthesopathy before they can treat it, but you still can treat the symptoms, like pain, in the meantime.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, may help relieve pain and swelling. But sometimes they might not be recommended, so check with your doctor before taking these pain relievers.
To treat conditions like spondylitis or psoriatic arthritis, your doctor might recommend one or some of these drugs:
Corticosteroid injections into your joint help reduce inflammation.
Biologics target your immune system to help treat psoriatic arthritis or spondylitis, among other diseases. These drugs include:
- Adalimumab (Humera)
- Certolizumab (Cimzia)
- Etanercept (Enbrel)
- Infliximab (Remicade)
Disease-modifying antirheumatic drugs (DMARDs) are medicines that slow disease progress. These include a class of drugs called JAK inhibitors. The most common DMARD is methotrexate, but others include:
- Leflunomide (Arava)
- Sulfasalazine (Azulfidine)
- Tofacitinib (Xeljanz)
Physical therapy
Physical therapy for enthesopathy focuses on helping you regain better range of motion in your joints with the least amount of pain -- or hopefully no pain at all. Your physical therapist will assess how you move your joint and how much pain it causes you. Then, they'll develop a treatment plan that typically includes regular visits so they can work with you and exercises for you to do at home.
Topical nitrate therapy
Topical nitrate therapy involves applying a nitroglycerin ointment to the painful area. The ointment helps relax or widen the blood vessels, improving blood flow. It also may help the blood vessels rebuild themselves.
Platelet-rich plasma (PRP) therapy
PRP is a therapy made from your own blood. After taking some blood from you, it is brought to a lab where it is separated into plasma and red blood cells. The plasma is then injected back where you have the pain. Researchers believe PRP helps the cells rebuild and promotes healing.
Home remedies for enthesopathy
You can take OTC pain relievers at home with your doctor's guidance. Resting your affected joint when possible and applying ice periodically can help too.
Enthesopathy and Arthritis Connection
Some kinds of arthritis are autoimmune disorders. This means your body's immune system makes chemicals that attack and damage your own tissues. This can cause enthesitis.
Two kinds of autoimmune arthritis -- psoriatic arthritis and ankylosing spondylitis -- can cause enthesitis. Psoriatic arthritis, which is common in people with the skin condition psoriasis, can affect your entire body. Ankylosing spondylitis mainly affects your spine.
Enthesitis also happens in some children with juvenile idiopathic arthritis, which can affect one or more joints. These children are described as having enthesitis-related arthritis (ERA).
Kids with juvenile arthritis often have a family history of inflammatory conditions, like ankylosing spondylitis, psoriatic arthritis, or inflammatory bowel disease.
Enthesopathy Complications
Over time, enthesitis can lead to:
Calcification or ossification. Inflammation of the entheses can cause new bone tissue to form. That new bone tissue gets in the way of normal movement and function -- like a bone spur on your heel.
Fibrosis. This causes tissues in the affected area to become ropey.
Tendon or ligament tear. If you have an enthesopathy caused by repetitive use or inflammatory disease, you are at risk of tearing a tendon or ligament.
Takeaways
Enthesopathy is a broad term for conditions that can affect your tendons and ligaments. Enthesitis is when they get inflamed and become painful because of injury, overuse, or disease. Your doctor needs to find out why you have an enthesopathy before it can be treated, but your doctor can do things to treat the pain in the meantime.
Enthesopathy FAQs
What is the best treatment for enthesitis?
There is no specific "best" treatment for enthesitis. Your doctor has to treat the condition that's causing it.
Will enthesitis go away?
Depending on the cause, enthesitis can go away for some people. For example, if it’s caused by overuse of a joint and you stop making that motion, after the joint heals it should be gone completely unless you start making those same movements again. But if it's caused by a disease like arthritis, it may be a long-term (chronic) condition.
What is the difference between enthesitis and enthesopathy?
Enthesopathy is the umbrella term for conditions that affect where tendons and ligaments meet bone. Enthesitis is what it’s called when the area gets inflamed and painful.
