Explaining the link between Psoriatic Arthritis and Enthesitis

A PsA diagnosis brings lots of things that you may or may not have expected, and we bet that a rapidly expanding medical vocabulary is one of the new skills that you didn’t necessarily see coming. But whether anticipated or not, phrases like Dactylitis, Cytokines and Spondylitis can quickly become as familiar as your ABCs. There may, however, be one phrase that you’re less familiar with; ever heard of Enthesitis? It’s not as commonly discussed, but it’s key to understanding how PsA can affect us. So let’s dust off the text books and get started!

Put simply, Enthesitis impacts around 35% of people living with PsA1 and is the inflammation of the Entheses, the place where tendons (which attach your muscles to your bones) and your ligaments (which attach bones to one another) insert into the bone.1 Fun fact: énthesis is actually the Greek for ‘putting in’ or ‘insertion’.

A recent study found that there are three risk factors (all totally independent to each other) for people with PsA developing Enthesitis.2 These are a higher BMI, higher actively inflamed joint count and also being a younger age.2 Interesting, around 15% of the study participants diagnosed with Enthesitis also had diagnosed Fibromyalgia, but whether there is a direct link between the two conditions is unclear. 2

So what’s actually happening in the body? Well, like a lot of things related to PsA, it’s rooted in inflammation.2 For people with PsA stress at the site of the enthesis can spark an overdrive in their immune system leading to the bone structure and surrounding area to come under attack.2 

Common places for Enthesitis to occur include the heel, knee, hip, toes, fingertips, elbow, backbone, and the bottom of your foot, and it’s a sensation of pain and stiffness often accompanied by swelling.2 A way to spot Enthesitis in the crowd of arthritic pains is that it’s often a pain felt either next to a joint or spread out over a wider area.2

The inflammation of the Entheses can, if left untreated, can lead to bone erosion in people living with PsA.2 In mild cases of inflammatory Enthesitis insoles and cushioning can often be recommended in addition to steroid injections directly into the site.2 If you’re concerned about Enthesitis, then make sure you speak with your doctor about diagnosis and symptom management.

[1] https://www.medpagetoday.com/rheumatology/arthritis/62495

[2] https://link.springer.com/article/10.1186/s13075-017-1399-5

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