Enthesitis

Enthesitis
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Field	rheumatology
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Enthesitis is inflammation of the entheses, the sites where tendons or ligaments insert into the bone.<ref>Maria Antonietta D'Agostino, MD,

 Enthesitis, 
 Best Practice & Research Clinical Rheumatology, 
 
 Vol. 20(Issue: 3),
 pp. 473–86,
 DOI: 10.1016/j.berh.2006.03.007,</ref><ref>

The Free Dictionary. Enthesitis(link). {{{website}}}.

</ref> It is an enthesopathy, a pathologic condition of the entheses. Manifest in inflammation or occasionally in fibrosis and calcification, enthesitis can be caused by recurring stress or by inflammatory autoimmune disease. 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.<ref name="Schett2017">,

 Enthesitis: from pathophysiology to treatment, 
 Nature Reviews Rheumatology, 
 
 Vol. 13(Issue: 12),
 
 DOI: 10.1038/nrrheum.2017.188,
 PMID: 29158573,</ref><ref name="Schmitt2017">, 
 Reactive Arthritis, 
 Infectious Disease Clinics of North America, 
 
 Vol. 31(Issue: 2),
 
 DOI: 10.1016/j.idc.2017.01.002,
 PMID: 28292540,</ref> Symptoms include multiple points of tenderness at the heel, tibial tuberosity, iliac crest, and other tendon insertion sites.

Images

Sagittal magnetic resonance images of ankle region: psoriatic arthritis. (a) Short tau inversion recovery (STIR) image, showing high signal intensity at the Achilles tendon insertion (enthesitis, thick arrow) and in the synovium of the ankle joint (synovitis, long thin arrow). Bone marrow oedema 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).

Related conditions

Anatomically close but separate conditions are:

• Apophysitis, inflammation of the bony attachment, generally associated with overuse among growing children.<ref name=Osgood-Schlatter>

OrthoKids - Osgood-Schlatter's Disease(link). {{{website}}}.

</ref><ref name=Kidshealth>

Sever's Disease(link). {{{website}}}. Kidshealth.org.

</ref><ref name="pmid15555843">Hendrix CL,

 Calcaneal apophysitis (Sever disease), 
 Clinics in Podiatric Medicine and Surgery, 
 2005,
 Vol. 22(Issue: 1),
 pp. 55–62, vi,
 DOI: 10.1016/j.cpm.2004.08.011,
 PMID: 15555843,</ref> 

• Tendinopathy is a disorder of the tendon, and is associated with direct injury or repetitive activities.<ref name=NIH2017>

Tendinitis(link). National Institute of Arthritis and Musculoskeletal and Skin Diseases.

12 April 2017.

</ref>

See also

• Enthesis (plural: Entheses)

External links

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