Enthesitis (ETT)
Enthesitis (ETT)
Enthesitis (ETT) is the inflammation of one or more entheses-the sites where tendons, ligaments, or joint capsules attach to bone14. It typically causes pain, stiffness, swelling, and tenderness at the affected attachment sites, often worsening with movement and leading to reduced mobility13.
Common Locations
Enthesitis can affect any enthesis but most commonly occurs at:
- The backbone (spine and sacroiliac joints)
- Heels (Achilles tendon insertion)
- Undersides of the feet (plantar fascia)
- Knees
- Hips
- Elbows and toes135
Causes
- Mechanical stress and overuse: Repetitive strain or injury to tendons or ligaments can cause microtrauma and inflammation35.
- Inflammatory diseases: Enthesitis is a hallmark of spondyloarthropathies such as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and inflammatory bowel disease-associated arthritis256.
- Genetic factors: Presence of HLA-B27 gene increases susceptibility, especially in spondyloarthropathies5.
- Infection: Reactive arthritis following gastrointestinal or genitourinary infections can trigger enthesitis5.
- Degenerative conditions: Osteoarthritis and aging-related changes can cause secondary enthesopathy5.
- Metabolic and systemic diseases: Diabetes, gout, sarcoidosis, and lupus may contribute5.
- Medications: Fluoroquinolone antibiotics and long-term steroid use can increase risk5.
Symptoms
- Localized pain and tenderness at tendon or ligament insertion sites
- Stiffness and swelling around affected joints
- Reduced range of motion due to pain
- In psoriatic arthritis, associated nail changes like pitting or discoloration may be present256
- Chronic inflammation can cause fibrosis and abnormal new bone formation (ossification), potentially leading to bone spurs and restricted movement35
Diagnosis
- Clinical evaluation of symptoms and physical examination
- Imaging: Ultrasound and MRI can detect inflammation and structural changes at entheses
- Laboratory tests to identify underlying inflammatory or infectious causes
- Assessment of associated conditions like psoriasis, inflammatory bowel disease, or HLA-B27 status25
Treatment
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids (local injections or systemic), disease-modifying antirheumatic drugs (DMARDs), and biologics (e.g., TNF inhibitors) for underlying inflammatory diseases
- Physical therapy: To improve flexibility, strength, and reduce mechanical stress
- Lifestyle modifications: Activity modification and weight management to reduce enthesis strain
- Pain management: Heat/cold therapy and analgesics as needed123
Clinical Significance
- Enthesitis is a key feature in diagnosing spondyloarthropathies, especially psoriatic arthritis and ankylosing spondylitis26.
- Recurrent or multiple enthesitis sites raise suspicion for systemic inflammatory arthritis rather than isolated mechanical injury25.
- Chronic enthesitis can lead to structural damage and functional impairment if untreated.
Summary Table
| Aspect | Details |
|---|---|
| Definition | Inflammation of entheses (tendon/ligament attachment sites to bone) |
| Common Sites | Spine, sacroiliac joints, heels (Achilles), feet (plantar fascia), knees, hips, elbows |
| Causes | Overuse/injury, inflammatory arthritis (PsA, AS), infection, genetics (HLA-B27), metabolic |
| Symptoms | Localized pain, stiffness, swelling, tenderness, reduced mobility |
| Diagnosis | Clinical exam, imaging (ultrasound, MRI), labs, HLA-B27 testing |
| Treatment | NSAIDs, corticosteroids, DMARDs, biologics, physical therapy, lifestyle changes |
| Clinical Importance | Diagnostic clue for spondyloarthropathies; can cause chronic disability if untreated |
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At DrStemCellsThailand (DRSCT)‘s Anti-Aging and Regenerative Medicine Center of Thailand, we emphasize comprehensive evaluations and personalized treatment plans of Cellular Therapy and Stem Cells for managing various health conditions. If you have questions about Enthesitis (ETT) or would like more information on our services, consult with our experts today!
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References1 Medical News Today: Enthesitis – inflammation of tendon/ligament attachment sites2 Cleveland Clinic: Enthesopathy & Enthesitis – symptoms, causes, treatment3 WebMD: Enthesopathy and Enthesitis – symptoms, causes, treatment4 Wikipedia: Enthesitis5 MedicineNet: Enthesitis and Enthesopathy – causes, symptoms, treatment6 Arthritis Foundation: Enthesitis and Psoriatic Arthritis7 CreakyJoints: What Is Enthesitis? Causes, Symptoms, Treatments8 NCBI Bookshelf: Enthesopathies – pathology and clinical features
Enthesitis is a painful inflammatory condition at tendon or ligament insertion sites, commonly linked to inflammatory arthritis. Early recognition and treatment are essential to prevent chronic pain and joint damage.
