Enthesitis and Psoriatic Arthritis
One of my pre-diagnosis symptoms of psoriatic arthritis was enthesitis. Of course, I didn’t know it at the time, but that was the name for the pain that radiated from my elbow up and even down my arm.
That pain came with it, such a lingering ache that it even made it difficult to move my arm at all on some days.
Enthesitis and psoriatic arthritis
If you are unfamiliar with enthesitis, basically it is inflammation in the area where the tendons and ligaments meet the bone. According to The American Journal of Clinical Dermatology, “Enthesitis is present in 35% of patients with PsA."1
In addition, The Lessons Learned from Imaging on Enthesitis in Psoriatic Arthritis states that, “The entheses are increasingly considered to be the primary site of joint inflammation in the spondyloarthropathies including psoriatic arthritis (PsA).”2
However, I would argue that many more patients experience it than the study suggests. This is because the actual pain from enthesitis can overlap with joint pain, making it (diagnostically speaking) very difficult to identify and distinguish.
The invisible pain of enthesitis
One of the first things that come to mind when you think about psoriatic arthritis is joint pain and deterioration. But in my experience, what is equally bad, and if not in some ways worse than psoriatic arthritis, is enthesitis.
The pulling and throbbing pain that comes with enthesitis is very difficult to manage, and for me, makes my arm nearly unusable. And yet, it doesn’t present like many psoriatic arthritis aches and pains because (at least in my case) there isn’t any telltale redness or swelling. It doesn’t look any different than any other part of my body.
But when I think about how bad the pain that I experience actually is, I feel like I should see the mangled remains of what should be an arm. But I don’t. On the outside, it just looks like a regular arm. And even my bloodwork showed no trace of the pain I was experiencing.
Tendons, ligaments, and Achilles – oh my!
Given my complex diagnostic journey, it should be no surprise that even my enthesitis can’t present itself “normally.” People predominantly experience it in their heels (Achilles) and the bottom of their feet as opposed to their elbows or other joint locations. For me, it was often at its worst towards the end of my workday when I was exhausted and on stress overload.
In fact, it was so bad that some days I even wondered if (despite my young age) I was having a heart attack and experiencing the pain in your arm that is associated with having a heart attack.
Enthesitis as a psoriatic arthritis symptom
Unfortunately, many doctors and other health care officials overlook or dismiss patients with enthesitis as a symptom of psoriatic arthritis. Patients can go additional months and often even years without the correct diagnosis and treatment because it often isn’t identified as a “primary” symptom in psoriatic arthritis.
That’s part of what makes psoriatic arthritis so sneaky. In reality, it presents itself in so many different ways and enthesitis seems more common than doctors give it credit for. Not to mention that enthesitis is also present in quite a large number of other conditions as well.
From a diagnosis standpoint, my doctor used ultrasound to really look at what was going on after I tried to describe where I was experiencing the pain.
In my experience, doctors are increasingly using different types of imaging, such as MRI (magnetic resonance imaging) and PET (positron emission tomography) scans. It actually felt very relieving to see visual evidence of the inflammation on the ultrasound with my own eyes.
I mean, I knew I experienced the pain, and it was terrible. However, there is something about literally seeing evidence of that pain with my own eyes that assured me that I wasn’t losing what was left of my mind.
Have you experienced pain in your entheses in addition to your PsA?
Trying to find relief from enthesitis pain
As is the case with many psoriatic arthritis symptoms, if you can manage the inflammation, then you can manage the pain. Enthesitis pain usually (in theory) responds to anti-inflammatory medicines (such as ibuprofen), ice, and plenty of rest.
Regardless, it always comes back to doing your best to manage your immune system and control the levels of inflammation in your body.
I’d love to know, have you experienced enthesitis with psoriatic arthritis? Do you believe that it is more prominent than the statistics initially suggest? Most importantly, how are you dealing with it? Share in the comments below!
Do you have a sleep disorder (eg. insomnia, sleep apnea, RLS) in addition to your PsA?