Enthesitis

{{short description|Inflammation where tendons and ligaments attach to bones}}

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Enthesitis is inflammation of the entheses (singular: enthesis), the sites where tendons, ligaments and joint capsules attach to bones.{{cite journal| title=Enthesitis | journal=Best Practice & Research Clinical Rheumatology | author=Maria Antonietta D'Agostino, MD | author2=Ignazio Olivieri, MD |publisher=Clinical Rheumatology |volume=20|issue=3 | pages=473–86 | doi=10.1016/j.berh.2006.03.007 | date= June 2006 | pmid=16777577}}{{cite journal |last1=Watad |first1=A |last2=Cuthbert |first2=RJ |last3=Amital |first3=H |last4=McGonagle |first4=D |title=Enthesitis: Much More Than Focal Insertion Point Inflammation. |journal=Current Rheumatology Reports |date=30 May 2018 |volume=20 |issue=7 |pages=41 |doi=10.1007/s11926-018-0751-3 |pmid=29846815 |pmc=5976708}}

It is a type of enthesopathy, meaning any pathologic condition of the entheses, with or without inflammation. There are some cases of isolated, primary enthesitis which are very poorly studied and understood. It is known to be associated with other autoimmune diseases, like spondyloarthropathies and psoriasis (thought to often precede psoriatic arthritis). A common autoimmune enthesitis is at the heel, where the Achilles tendon attaches to the calcaneus.

It is associated with HLA B27 arthropathies, such as ankylosing spondylitis, psoriatic arthritis, and reactive arthritis.{{cite journal|last1=Schett|first1=G|last2=Lories|first2=RJ|last3=D'Agostino|first3=MA|last4=Elewaut|first4=D|last5=Kirkham|first5=B|last6=Soriano|first6=ER|last7=McGonagle|first7=D|title=Enthesitis: from pathophysiology to treatment|journal=Nature Reviews Rheumatology|date=November 2017|volume=13|issue=12|pages=731–41|doi=10.1038/nrrheum.2017.188|pmid=29158573|type=Review}}{{cite journal|last1=Schmitt|first1=SK|title=Reactive Arthritis|journal=Infectious Disease Clinics of North America|date=June 2017|volume=31|issue=2|pages=265–77|doi=10.1016/j.idc.2017.01.002|pmid=28292540|type=Review}}

Signs and symptoms

Early clinical manifestations are an aching sensation akin to "working out too much", and it gets better with activity. It is worse in the morning (after sleeping and not moving). The muscle insertion hurts very focally as it joins into the bone, but there is little to no pain at all with passive motion.

Symptoms include multiple points of tenderness at the heel, tibial tuberosity, iliac crest, and other tendon insertion sites.

Diagnosis

File:Psoriatic arthritis ankle ar1934-3.gif is seen at the tendon insertion (short thin arrow). (b, c) T1 weighted images of a different section of the same patient, before (panel b) and after (panel c) intravenous contrast injection, confirm inflammation (large arrow) at the enthesis and reveal bone erosion at tendon insertion (short thin arrows).]]

Management

Non steroidal anti-inflammatory drugs (NSAIDs).
corticosteroid injections.
Disease-modifying anti-rheumatic drug (DMARD).

Related conditions

Anatomically close but separate conditions are:

Apophysitis, inflammation of the bony attachment, generally associated with overuse among growing children.{{Cite web | url=http://orthokids.org/Condition/Osgood-Schlatter-s |title = OrthoKids - Osgood-Schlatter's Disease}}{{cite web|url=http://kidshealth.org/parent/medical/bones/severs_disease.html |title=Sever's Disease |publisher=Kidshealth.org |access-date=2014-04-29}}{{cite journal |author=Hendrix CL |title=Calcaneal apophysitis (Sever disease) |journal=Clinics in Podiatric Medicine and Surgery |volume=22 |issue=1 |pages=55–62, vi |year=2005 |pmid=15555843 |doi=10.1016/j.cpm.2004.08.011}}
Tendinopathy is a disorder of the tendon, and is associated with direct injury or repetitive activities.{{cite web |title=Tendinitis |url=https://www.niams.nih.gov/health-topics/tendinitis/advanced |website=National Institute of Arthritis and Musculoskeletal and Skin Diseases |access-date=18 November 2018 |language=en |date=12 April 2017}}

References

External links

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Category:Rheumatology