Enthesitis and Enthesopathy

A Professional Resource for Patients and Doctors Relating to Disorders of the Enthesis

An enthesis is a point of attachment or insertion point of a sinew (tendon or ligament) to the bone. This image shows the foot and the Achilles enthesis or tendon insertion point in cartoon form. The Achilles is the largest enthesis or insertion in the body but a multitude of such insertions hold the entire skeleton together and allow movement. Disorders of the numerous tendon or ligament attachment sites around the body is a major cause of pain, suffering and disability. Diseases of the enthesis are still poorly recognised and appreciated by many doctors. This site provides information for patients and doctors and is being developed by leading internationally known doctors and scientists in the field of enthesis research.

If you suffer from unexplained joint pain, then check it out .... Learn more »

Enthesis Anatomy & Physiology

Historically, all entheses have long been considered as focal attachments to bone. However, it is increasingly recognised that in many cases the enthesis is really just part of an enthesis organ. An organ is a group of related tissues that function together to carry out a specific task ....

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Enthesis Damage and Repair

Given that insertions are sites of high physical stressing they are consequently associated with damage. This must be repaired to maintain skeletal integrity. This section discusses enthesis repair in health and disease and will describe both soft tissue and bone changes ....

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Imaging the Enthesis

With the emerging importance of the enthesis in disease there is an increasing need to better visualise this structure. This section contains information on key imaging features that aid in the recognition of enthesopathy and in differentiating this from other joint pathologies ....

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Ankylosing Spondylitis

This is a primary inflammatory polyenthesitis of the spine. Inflammation in most other tissues leads to their destruction but this not the case in the spine. The opposite occurs whereby enthesitis is associated with florid tissue repair and new bone formation at entheses ....

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Psoriatic Arthritis

Psoriatic Arthritis has a diverse array of clinical presentations that include a severe multi-joint inflammatory arthritis, spinal inflammation and a group of conditions associated with bone destruction. Animal models with features of Psoriatic Arthritis clearly show ....

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Psoriasis, Nails & Enthesopathy

Dermatologists now appreciated that a significant proportion of their cases, in the region of a third, also have joint pains even they do not have a recognised diagnosis of Psoriatic Arthritis. Dermatologists also recognise that nail involvement and scalp disease may be most strongly ....

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Enthesis in Undifferentiated Spondyloarthritis

Many patients present with a pattern of enthesitis related arthritis termed undifferentiated spondylarthropathy. This may evolve into Ankylosing Spondylitis or Psoriatic Arthritis or gut related inflammatory arthritis but in up to 50% of cases the diagnosis does not change ....

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Enthesis in Osteoarthritis

Historically Osteoarthritis was viewed as a disease of wear and tear of the cartilage lining the ends of bones. Studies in subjects with some forms of Osteoarthritis have now shown that some types of OA start at the enthesis and adjacent ligaments. The enthesis is the sleeping giant of ....

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Other Diseases of the Enthesis

A wide array of Rheumatic disorders and drug therapies may affect the enthesis. These include Rheumatoid Arthritis and Gout and connective tissue disorders. Several drugs can also contribute to enthesopathy related pains and dysfunction ....

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Miscellaneous & Case Studies

This section contains "real world" cases where patients were not recognised as having enthesitis related pathology or the diagnosis was delayed. It also contains information on cases who had the wrong type of enthesopathy diagnosed and consequently had inappropriate therapy ....

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Treatment of Enthesis Related Diseases

The Anti-TNF therapies were the first proven therapies for enthesitis. This discovery coincided with the use of Magnetic Resonance Imaging scanning that could show just how effective these agents were for switching off inflammation. The initial studies suggested that some agents were better than others ....

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Research

Despite the great advances in understanding enthesopathy since the mid 1990's this field is still in its infancy. This section is aimed more at scientists and doctors and provides information about the cellular and molecular basis for disease at insertion points ....

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