Psoriatic enthesitis can cause pain and inflammation in the tendons or ligaments that connect to bones. It is commonly associated with psoriatic arthritis.
Psoriatic arthritis is a form of chronic, inflammatory arthritis. Although it can occur on its own, doctors often diagnose it in people living with psoriasis.
Symptoms such as joint pain, stiffness, and swelling typically affect the joints in the fingers, wrists, ankles, and feet. However, they can also affect the knees and even the back and pelvis. As with psoriasis, there is no cure for psoriatic arthritis.
Enthesitis is a separate condition that occurs when the ligaments and tendons that connect to the joints (known as entheses) become inflamed and painful.
Although anyone can develop enthesitis, people living with psoriatic arthritis have a higher chance of getting the condition. About 1 in 3 people living with psoriatic arthritis develop enthesitis.
Placing repeated stress on an enthesis can cause it to become inflamed. This inflammation can bring on symptoms in the affected area, such as:
- puffy fingers or toes
In a person who does not have psoriatic arthritis, icing and resting the affected enthesis typically helps it heal.
However, if psoriatic arthritis is also present, the activity of the overactive immune system perpetuates the inflammation in the enthesis instead of allowing it time to heal.
If a doctor diagnoses enthesitis, a person may need to change their psoriatic arthritis treatment plan.
According to the Arthritis Foundation, enthesitis does not respond to disease-modifying antirheumatic drugs (DMARDs). These are among the drugs that doctors use as a first-line treatment for psoriatic arthritis.
A doctor may prescribe a high dose of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat enthesitis in people who do not have kidney disease or gastrointestinal issues. A person may take these drugs for up to a month to see whether the enthesitis improves.
When enthesitis is localized to one area, a doctor may recommend a corticosteroid injection to tame inflammation.
If the symptoms persist or affect multiple areas of the body, a doctor may recommend one of the biologic treatments that they also use to treat psoriatic arthritis.
The findings from a 2019 study showed that the following biologic drugs are effective in treating enthesitis:
- anti-TNF-alpha (infliximab, golimumab, adalimumab)
- anti-interleukin-12/23 (ustekinumab)
- anti-interleukin-17 (secukinumab, ixekizumab)
A person should talk with their doctor about the treatment options that are most likely to be safe and effective for them.
According to the advocacy group Global Healthy Living Foundation, some common home remedies may also help alleviate symptoms of enthesitis. These include:
- applying an ice pack or heating pad to the affected joint
- resting and elevating the affected joint
- soaking in an Epsom salt bath
- wearing compression socks, wraps, braces, or other supportive items
- wearing special shoes or shoe inserts
A physical therapist can also recommend gentle stretches to help alleviate symptoms of enthesitis.
According to the Arthritis Foundation, most cases of enthesitis develop soon after the initial diagnosis of psoriatic arthritis. However, the condition can occur at any time.
In a person with psoriatic arthritis, enthesitis often affects the heel of the
foot. It also commonly affects the elbows, shoulders, hips, and knees, though the symptoms can occur around nearly any joint.
Over time, a person may also develop bone spurs that can cause additional pain and issues with movement.
Other associated issues include nail pitting and separation of the nail from the nail bed in a person’s fingers and toes. These symptoms also commonly occur in psoriatic arthritis.
According to a 2018 study, doctors can use various imaging tests to help them diagnose enthesitis, such as:
- conventional radiography
In many cases, though, a doctor can diagnose enthesitis just by reviewing a person’s medical history and evaluating their symptoms.
It may not be possible to prevent enthesitis, but a person can help minimize its effects by making certain lifestyle changes.
For example, reaching or maintaining a moderate weight may help alleviate pressure on affected joints and entheses. Avoiding excessive salt in the diet can also help control swelling.
The authors of a 2018 study note that prompt diagnosis and treatment can help reduce psoriatic arthritis disease activity, improve symptoms, and prevent joint damage. Therefore, seeking a diagnosis at an early stage can help prevent serious outcomes and lead to an improved quality of life.
A person should talk with their doctor if they suspect that they may have enthesitis. A doctor can often diagnose the condition by carrying out a physical examination, reviewing the person’s medical history, and, in some cases, using imaging techniques.
A person should also seek medical advice if they are no longer responding to their medications. A doctor can recommend any necessary changes in treatment to help ease the symptoms and prevent complications, such as the development of bone spurs.
Enthesitis is a condition that can cause pain, swelling, and stiffness in the tendons and ligaments surrounding the joints. Psoriatic arthritis and enthesitis often occur together.
Early diagnosis and treatment of enthesitis can help improve a person’s long-term outcome. A typical treatment plan may include NSAIDs, corticosteroid injections, or biologic drugs. Certain at-home treatments may also help alleviate enthesitis symptoms.