Enthesitis: Causes, Risk Factors, Symptoms, Diagnosis and Treatment

Tendons are tissues that attach their muscles to bones.

The ligaments connect the bones. The area where tendons and ligaments attach to bones is called entheses.

This connection point can be irritated due to injuries or other diseases. This condition is known as enthesitis or enthesopathy.

Enthesitis manifests as soft tissue irritation such as tendons, ligaments, and muscles where these tissues enter the bones.

This condition can arise due to a disease of the joints and is generally seen as the main sign of a condition known as spondyloarthritis.

Enthesitis is also associated with diffuse idiopathic skeletal hyperostosis.

Entheses irritation can lead to the formation of new bone tissue that affects its normal mobility to perform other functions.


Enthesitis is very prevalent in people who have arthritis and also occurs in children with juvenile idiopathic arthritis. Juvenile idiopathic arthritis is an autoimmune disorder in which the immune system attacks cells and tissues and causes inflammation.

Although enthesitis is not commonly associated with osteoarthritis and adult rheumatoid arthritis, these people may have this condition.


Enthesitis can occur as a result of different things, which include:

Defective genes: Enthesitis can be inherited. When one of his family members manifests this condition, you are more likely to inherit those mutated genes that cause enthesitis.

Proinflammatory cytokines: Cytokines control your body’s reaction to inflammation, infection, and trauma.

Some cytokines can be harmful to your body by causing inflammation and are called proinflammatory. Other cytokines can relieve inflammation and, therefore, increase healing.

When administered to humans, proinflammatory cytokines such as interleukin (IL) -1 and tumor necrosis factor (TNF) can destroy tissues and cause inflammation and even death.

Autoimmune diseases: Autoimmune disorders cause unusual activity of the immune system; It can cause excessive activity or reduced activity of your immune system.

During excessive activity, your immune system attacks and destroys body tissues. This reduces your body’s ability to fight and protect against infections. Therefore, your body is vulnerable to any disease.

An example of an autoimmune disease is rheumatoid arthritis. Rheumatoid arthritis occurs when the immune system secretes antibodies that attack the lining of the joints and produce painful swelling.

If rheumatoid arthritis is not treated for more extended periods, it will damage the joint.

Risk factors for enthesitis

There are many factors associated with enthesitis. People with rheumatic and non-rheumatic swelling conditions are more susceptible to enthesitis.

In addition, people suffering from the following diseases are more likely to develop enthesitis:

  • Arthritis psoriásica.
  • Enteropathic arthritis
  • Ankylosing spondylitis.
  • Septic arthritis.
  • Spondyloarthropathies.


Enthesitis usually occurs in areas around the knee, elbow, hip, toes, fingertips, spine, and lower part of the foot.

You will likely notice swelling near the areas mentioned above. You will feel pain and stiffness when moving. There is a pain in the back of his heel, and it makes it difficult to climb stairs.

When your condition worsens without treatment, your tendons and ligaments become thick, swollen, and stiff, making your movement painful and difficult.


Physical evaluation: The diagnosis of enthesitis begins with a physical examination. The doctor touches the knee, elbow, hip, toes, fingertips, spine, and lower part of the foot to detect swelling, pain, and redness.

The doctor will check your joints to determine if there is any reduced movement.

Medical tests: Your doctor may perform several tests to determine the cause of this condition.

These tests are erythrocyte sedimentation rates to help detect any inflammation and infection. The complete blood count is used to rule out the disease as the cause.

X-Rays: X- rays can be used to determine any variation in enthesitis and bones.

MRI and ultrasound: These imaging tests produce complete details of enthesitis and are used to detect inflammation in the soft tissues.

Treatment for enthesitis

Enthesitis treatment prevents inflammation or slows down your immune system or defense mechanism.

The following are treatment options you may receive when diagnosed with enthesitis:

NonsteroidaNonsteroidalmmatory drugs (NSAIDs): These medicines are used to relieve pain and swelling. They block enzymes such as ox-1 and Cox-2 to produce prostaglandins responsible for swelling and pain.

By blocking the secretion of prostaglandins, your body relieves itself of pain and swelling. Non-steroidNonsteroidalmmatory drugs can be bought in the market or prescribed by the doctor. Examples include aspirin, ibuprofen, Voltaren, etc.

Biological: These are genetically modified proteins obtained from human genes. They are used to block some components of your immune system that cause inflammation.

They are used to slow down the spread of rheumatoid arthritis. Biological products can cause pain and rashes at the injection site of your body. It can also cause an allergic reaction, fever, nausea, headache, flu, and chills.

Biological products can also cause chronic diseases such as tuberculosis. People with multiple sclerosis and acute conditions such as congestive heart failure should not use natural products.

The following are biological products that your doctor can give you:

  • Actemra.
  • Amjevita.
  • Cimzia.
  • Enbrel.
  • Erelzi.

Prednisone: A corticosteroid medication used to reduce inflammation and control your immune system. You should not take prednisone if you have a yeast infection or are allergic to this medicine.

Prednisone can be harmful to you. Therefore, tell your doctor if you have any of the following symptoms:

  • Kidney diseases
  • Hepatic cirrhosis.
  • Diabetes.
  • Tuberculosis
  • Malaria.
  • A thyroid disorder.
  • Mental illness.
  • Pregnant.

Prednisone can cause you to develop the following side effects:

  • Blurry vision.
  • Rapid weight gain
  • Swelling.
  • Acute depression

Methotrexate: Methotrexate is a medicine used to control your immune system by minimizing your activities. The medication also alters the process that causes the disease to limit damage to your joints.

Some of the common side effects of methotrexate are vomiting, nausea, mouth ulcers, headaches, and fatigue. However, these side effects can be treated when taking folic acid supplements.

Sulfasalazine: This medication can treat swelling and pain in arthritis. This medication also protects your joints from any form of injury or damage.

Breastfeeding mothers should not use sulfasalazine because it can cause brain complications in infants under two years of age. It can also decrease sperm production in men, but this will improve when you stop taking it.