The Connection Between Enthesopathy and Rheumatoid Arthritis

Enthesopathy is a condition where there is a problem with the attachment of tendons, ligaments, or other parts of a joint onto the bone. This often results in pain, and the affected individual may also experience stiffness or difficulty moving that part of the body. People who have rheumatoid arthritis (RA) will sometimes have enthesopathy as a result of their inflammatory disease. When this occurs, it is called enthesitis.

While both enthesitis and enthesopathy have strange and unique names, their symptoms are the same. Sometimes the individual will just feel generalized joint pain, while other times he or she will feel pain at a specific location near the joint. Movement typically aggravates the symptoms. Enthesopathy that is related to other conditions such as RA can be treated by addressing the underlying cause. Sometimes this may mean lifestyle changes and physical therapy.

What causes enthesopathy?

There are a handful of things that can cause this painful syndrome. Often overuse, particularly from repetitive movements, is the culprit. Take a moment to think about how much strain you put on the joints of your body in a given day. It’s no wonder you can develop enthesopathy from repetition. Sports such as running or playing tennis could be the cause, and typing on a computer all day and every day could certainly do it.

Other causes include trauma such as a fall or getting hit in a particular area. As we have previously mentioned, autoimmune diseases such as RA are also a causative factor. Additionally, there are a number of genetic conditions that can predispose people to certain injuries. The most common sites for enthesopathy to develop are the heel, knees, hips, fingers, toes, elbows, and bones of the back. Tendons are bundles of connective tissue that attached muscles to bones, while ligaments are bundles of connective tissue that attach bones to other bones. The enthesis is the bundle of tissue that attaches ligaments, tendons, and the joint capsule to the bones, and is where this condition gets its name. Any location that has tendons or ligaments could become a site for enthesopathy to set in.

What are the symptoms?

Swelling, stiffness, and pain in the joint are all symptoms of enthesopathy. Usually the diagnosis process starts when a healthcare provider presses on a tendon or ligament where it inserts into the bone and the patient feels pain. Other symptoms include difficulty moving the effected joint, swelling, and warmth near the affected area.

Usually enthesopathy is a symptom of another disorder as it is with RA. This can make identifying symptoms and properly diagnosing the condition difficult. At the same time, having these other symptoms could help identify the root cause of the joint pain, which could ultimately lead to more effective treatment. For example, Gout is a painful arthritic condition where uric acid crystals deposit in and around a variety of joints, particularly those of the feet and toes.

Diagnosis and treatment

No special imaging or lab work is necessary to diagnose enthesopathy. A healthcare provider can provide you with a diagnosis after an exam and description of your symptoms. However, scans and imaging may be necessary if symptoms are unclear. Sometimes an ultrasound, X-ray or magnetic resonance imaging (MRI) scan, can help the healthcare provider rule out other causes for your pain.

Treatment types vary. They can include medications, physical therapy, orthotics, and/or lifestyle changes. People with enthesopathy can often use arthritis medications to help. Non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen are commonly used. If the symptoms are related to an autoimmune condition, biologics can be used. Sometimes other medication such as corticosteroids can be used for symptomatic treatment.

Physical therapy is used to help people with all sorts of joint conditions. Usually this focuses on strengthening and loosening tense muscles while also improving flexibility. Physical therapy usually begins with the patient seeing the physical therapist for guidance, and then he or she will continue the stretching and exercises at home. When doing physical therapy alone at home it is important to not get lazy! By doing the exercises on both sides of the body, muscle imbalances, problems with posture, and worsening pain can be prevented. This is also a great way for people to work around their injuries with guidance from a trained professional without making the situation worse.

Orthotics are devices that provide support to a body part and can help relieve symptoms. Heel cup shoe inserts are one example that can help reduce the pain of certain types of enthesopathy. In addition to alleviating current symptoms, orthotics can also prevent further injury. Splints can be particularly useful while sleeping by slowly and carefully supporting and stretching the joint muscles.

Last but certainly not least, we all know that lifestyle changes are often the missing key to remedying a health problem. People who have enthesopathy may need to look at their lifestyle a bit to think about what changes could help them. Avoiding exercises that irritate the condition is important. If you continue running while you have enthesopathy of the knee, you are not likely going to be able to alleviate your symptoms with the above treatment options. Exercise is of course still important. Activities like biking, swimming, and rowing can be a bit less stressful on the joints and still provide you with a great work out. There are loads of other things that could be helpful as well. Some of these may not be commonly mentioned by healthcare providers, but have been used as healing methods for centuries. 

Cold or hot packs, and especially alternating between the two can help reduce inflammation and thus pain. Massage and acupuncture can also help with pain. Overall, like any condition, it is important to listen to your body. You know when something is not right, and you know when something is not working for you. You are the expert of your own health. The expertise of healthcare providers should of course be leveraged to get you the correct diagnosis and on the right track with beginning your treatment process. There are a number of conditions that can seem similar to enthesopathy, but that require different treatment methods, so it is important that you do not self-diagnose. For example, swelling and warmth near a joint in the leg could signify a blood clot, which is a life-threatening condition. While it is important to listen to your intuition, it is also important to seek expert advice and care.

What is the prognosis like?

This is tough to answer, because as mentioned earlier in this article, there are many causes of enthesopathy, and the prognosis depends on how the cause is treated. In general, the symptoms of the condition can improve over time if given the correct treatments, but long-term prognosis really depends on the underlying cause. If a chronic illness is the cause, flare ups can exacerbate the enthesopathy throughout the body. If it is a result of overuse, stopping the repetitive movements that caused it in the first place will often do the trick. This condition can do permanent damage to the joint if left untreated, so if you have any concerns, be sure to see a healthcare provider for advice!