Enthesitis is a frequent symptom of multiple diseases that generates intense pain in those who suffer from it. Fortunately, its treatment is simple and the risk of complications is low if an early diagnosis is made.
All the muscles of the body have a bony insertion, which allows them to generate a specific movement by contracting their fibers. The area of attachment of a muscle tendon, ligament, or fascia to a bone surface is known as enthesis.
Enthesitis is a term that refers to the inflammation of one or more entheses in the body, which can occur due to multiple pathologies. Some studies show that this inflammation is a cardinal sign of spondyloarthritis, although it may be due to other situations such as the consumption of some drugs.
When inflammation is not treated in a timely manner, calcification can occur in the area and permanently damage enthesis.
The inflammation appears after the release of pro-inflammatory substances from regions close to enthesis. This release occurs by various stimuli such as overexertion of the joint or repetitive movements.
The main symptom reported by patients with enthesitis is pain in the affected area, which can spread throughout the entire bone. Inflammation is most common in the knee, elbow, heel, hip, and fingers, so pain usually appears in these areas.
This pain is characterized by its acute onset, with a highly variable intensity, which increases with movement of the nearest joint. However, patients with this pathology may present other symptoms, including the following:
Inflammation of the joint
Redness and increased temperature in the area.
Tenderness to palpation.
When inflammation persists for a long time, calcium can build up in the affected tendon. This accumulation will generate the appearance of spines or bone malformations, which can be painful. The malformations in question can interfere with the normal movement of the joint.
What can cause enthesitis?
Enthesitis occurs from the release of cytokines and other pro-inflammatory substances near enthesis. The release of these types of substances can have various origins, from a direct trauma to the region, to the performance of a repetitive movement or sports injuries.
People with certain rheumatic diseases (such as arthritis) can often develop enthesitis. However, this is not the only cause, since the consumption of certain drugs can generate the appearance of the problem.
Enthesitis is one of the main symptoms presented by people with spondyloarthritis. This is a term used to group various types of arthritis with common characteristics. They frequently affect young and obese people, and the lumbar region, legs and arms may be compromised.
A study published in the Colombian Journal of Rheumatology establishes that up to 35% of patients with these diseases have enthesitis. It also establishes that the most affected areas in these cases are usually the sole of the skin, the outer side of the ankle and the Achilles tendon.
Among the different pathologies that make up the group of spondyloarthritis, the following stand out:
Reiter’s syndrome or reactive arthritis.
Juvenile idiopathic arthritis.
Spondyloarthritis associated with inflammatory bowel disease.
Diagnosis and treatment
Traumatologists or rheumatologists are the most indicated specialists to diagnose this condition. It will be based on the symptoms presented and the corresponding physical evaluation, although in most cases imaging studies are necessary to confirm the diagnosis.
The doctor should inquire about the appearance of symptoms and their intensity. He will also ask about the personal history and if the patient suffers from any of the diseases framed in spondyloarthritis. In addition, it is important to evaluate the affected area to check for sensitivity and look for signs of inflammation.
The Spanish Association of Pediatrics establishes that ultrasound is useful when detecting acute inflammation of the enthesis, which is why it is the imaging study of choice. However, other tests such as an X-ray and MRI may be done.
Treatment of enthesitis will depend on the severity of the situation. In most cases, rest in combination with the consumption of non-steroidal anti-inflammatory drugs such as naproxen is usually sufficient to alleviate the ailment.
Performing physical therapy exercises helps patients with long-standing illnesses to improve joint mobility. In the most severe cases of the disease, surgery may be necessary, especially if there is calcification of the tissue.
Enthesitis prevention and recommendations
In most cases, it is not possible to prevent the appearance of enthesitis, since it is associated with genetic diseases. In these cases, it is only possible to learn to live with the disease, so simple measures such as fully complying with treatment and having adequate medical control are essential to reduce pain.
This injury is very common in high-performance athletes, in whom it is related to poor movements or trauma. In this sense, athletes can follow the following recommendations to reduce the risk of suffering from enthesitis:
Do a good warm-up and stretch all the joints.
Wear suitable footwear for sports practice.
Use all protective instruments such as knee and elbow pads.
Perform the movements precisely, taking care to have a correct technique.
Do not subject the body to excessive forces.
A condition that can limit the lives of the very young
Enthesitis is nothing more than the inflammation of an area called enthesis, which causes great pain. One of the main causes of this condition is spondyloarthritis, a group of diseases of various kinds that affects younger people.
All the pathologies that are included in spondyloarthritis have a cyclical nature, so that periods with and without pain alternate. When the disease is active, the pain can be so severe that it limits normal movements, significantly affecting daily life.
Timely diagnosis and treatment of the disease are very important aspects if you want to reduce functional limitation and avoid complications. In this sense, people should go to a specialist at the first signs that indicate the presence of the condition.