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Enthesitis is
inflammation
Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...
of the entheses
The enthesis (plural entheses) is the connective tissue between tendon or ligament and bone.
There are two types of entheses: ''Fibrous entheses'' and ''fibrocartilaginous entheses''.
In a fibrous enthesis, the collagenous tendon or ligament dire ...
, the sites where tendons or ligaments insert into the bone. It is an enthesopathy, a pathologic condition of the entheses. Early clinical manifestations are an aching sensation akin to "working out too much", and it gets better with activity. It is worse in the morning (after sleeping and not moving). The muscle insertion hurts very focally as it joins into the bone, but there is little to no pain at all with passive motion. There are some cases of isolated, primary enthesitis which are very poorly studied and understood. It is known to be associated with other autoimmune diseases, like spondyloarthropathies and psoriasis (thought to often precede psoriatic arthritis). A common autoimmune enthesitis is at the heel, where the Achilles tendon
The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcane ...
attaches to the calcaneus
In humans and many other primates, the calcaneus (; from the Latin ''calcaneus'' or ''calcaneum'', meaning heel) or heel bone is a bone of the tarsus of the foot which constitutes the heel. In some other animals, it is the point of the hock.
...
.
It is associated with HLA B27 arthropathies, such as ankylosing spondylitis
Ankylosing spondylitis (AS) is a type of arthritis characterized by long-term inflammation of the joints of the spine typically where the spine joins the pelvis. Occasionally areas affected may include other joints such as the shoulders or hi ...
, psoriatic arthritis
Psoriatic arthritis is a long-term inflammatory arthritis that occurs in people affected by the autoimmune disease psoriasis. The classic feature of psoriatic arthritis is swelling of entire fingers and toes with a sausage-like appearance. ...
, and reactive arthritis. Symptoms include multiple points of tenderness at the heel, tibial tuberosity, iliac crest
The crest of the ilium (or iliac crest) is the superior border of the wing of ilium and the superiolateral margin of the greater pelvis.
Structure
The iliac crest stretches posteriorly from the anterior superior iliac spine (ASIS) to the poste ...
, and other tendon insertion sites.
Images
Related conditions
Anatomically close but separate conditions are: * Apophysitis, inflammation of the bony attachment, generally associated with overuse among growing children. * Tendinopathy is a disorder of the tendon, and is associated with direct injury or repetitive activities.See also
*Enthesis
The enthesis (plural entheses) is the connective tissue between tendon or ligament and bone.
There are two types of entheses: ''Fibrous entheses'' and ''fibrocartilaginous entheses''.
In a fibrous enthesis, the collagenous tendon or ligament dir ...
(plural: Entheses)
References
External links
Rheumatology {{Musculoskeletal-stub