Community Views: Time to Talk Enthesitis
Time to talk what?! Living with psoriatic arthritis (PsA), you may or may not have heard of enthesitis. Enthesitis is inflammation of the entheses. These are the places where bones join and are entered by tendons and ligaments.
Anyone can have enthesitis, but without PsA, it is usually episodic, not chronic. Rheumatologists often look for enthesitis when diagnosing PsA. The presence of enthesitis confirms PsA and rules out rheumatoid arthritis.1
Let's hear what real patients have to say...
Given both the frequency of this symptom of PsA and many people’s lack of familiarity with the term, we wanted to gain the community’s perspective. We recently asked followers of the Facebook page, “Have you experienced enthesitis along with psoriatic arthritis? How are you dealing with it?”
As always, you had great insights to share!
Location, location, location
Over 100 entheses exist in the body. Entheses occur wherever a tendon or ligament enters the bone. One of the most common sites of enthesitis is where the heel connects to the Achilles tendon. You shared the various points that cause you the most pain with PsA.1
“Elbows, ankles, feet, wrists, shoulders.”
“Yes. My heels are driving me crazy.”
Feet, wrists, and costochondritis (cartilage in the rib cage) are the worst!!!”
"It’s by far the most painful part.”
Many respondents wrote that enthesitis is the worst symptom. Enthesis pain is severe.2 The compromised immune system keeps the entheses inflamed, making the symptoms chronic.1Addressing the inflammation to mitigate the pain is difficult with PsA.1
“Yes, this is the most debilitating symptom I have to deal with (primarily in the feet and knees).
“It is the absolute worst. I can barely use my arms right now because of it.”
“My PsA is almost entirely enthesitis.”
“It’s my primary symptom. It has hit every part of my body over the years.”
Addressing the underlying inflammation that causes enthesitis is difficult with PsA. Pain management becomes vital. Enthesitis is treated with corticosteroid injections when limited to one spot. Most people with PsA have more widespread enthesitis. In these cases, non-steroidal anti-inflammatory drugs (NSAIDs) and biologics may help manage the pain. Having home remedies is a valuable tool. Your responses included many favorites.1
“Heating pad, daily meds, and weekly injections.”
“THC oil applied several times a day is a lifesaver for me.”
“Heat wraps, ice, Voltaren gel, arthritis gloves.”
“The only thing that’s worked for me is prednisone.”
“Hot baths, pain meds, Voltaren gel, and PT.”
“KT tape has been my savior.”
“I find that if I try to remain gently active and alternate with rest it helps more than heat or ice.”
“The great part about this post is I realize I am not alone and have so many people dealing with similar issues.”
The collective wisdom of this community is so valuable. Thank you all for sharing your experiences and contributing to the conversation!
Do you have a sleep disorder (eg. insomnia, sleep apnea, RLS) in addition to your PsA?