Enthesitis

I've self-diagnosed enthesitis in various places. At my last appointment I did ask about it and my rheumy replied "Mmm, um, erm" or words to that effect. Which I suppose might be doctor-speak for "Haven't we got quite enough to deal with in this appointment?"

Is it possible to detect enthesitis? Do x-rays show it for example? Or is it just diagnosed from symptoms?

Its diagnosed by pushing on the enthesitis points hard enough that the white shows on the examiners fingernails If the patient is screaming in pain, kicks the doc, or passes out, its enthesitis. Baring that until there is a slight muscle contraction on the other end of the tendon and tenderness along the entire sheath radiating from the primary entheses point. By the time its developed enough to show up on an xray, you don't need an xray. MRI etc are a crapshoot.

Then the is the new fangled Ultrasonography with power Doppler (US-PD) machines some rheumies are using.His "Mmm, um, erm" may have been Brit for "DUH!" if you have PsA, you have enthesitis. The only question is how much and where................

So very true! Initially I had thought that, with treatment, most of the inflammation would go away, but my doctors have disabused me of that notion. PsA means there will always be (unless a person reaches total remission) enthesitis, and bursitis, and tendinitis, etc. It's all about keeping stuff stretched out when it needs to be, or keeping it stable if it shouldn't be stretched out, and otherwise staying strong and healthy. :) I still want to know what's going on though, because it's my body... seems like I should get to know what's what.

tntlamb said:

His "Mmm, um, erm" may have been Brit for "DUH!" if you have PsA, you have enthesitis. The only question is how much and where................

If you ever look a REAL skeleton there are actually 741 entheses. Most are no bigger than a pencil lead some smaller a few bigger. Then think of the tendon stuffed into the little hole and how VERY VERY little inflammation it takes to put enough pressure to cause a lot of pain. Its amazing how the tiniest thing can cause so much grief. I remember the first kidney stone I passed. I swear to gosh I gave birth to a heifer calf. When they used those itsy bitsy tweezers to get it off the filter...... I was mortified and I really did know what a kidney stone was. My grandpa had one the size of a walnut on the mantle.

Interesting. I think the smaller stones are more painful. Mine was 3mm-supposedly small enough to pass but extremely painful and it caused a lot of bleeding. My daughters was 7mm and didn't leave her kidney. It had to be blasted to smitherenes, and I don't think she had the amount of pain I had.

Giving birth--more painful yet. As far as I know, no man has ever experienced it. Someone once said, imagine grabbing your top lip and pulling it over your head. That's what giving birth feels like. (I hope I didn't scare anybody who is contemplating having their first child.)

So, are those entheses on the tops of the feet? Mine don't look swollen anymore but they can sure hurt!

tntlamb said:

If you ever look a REAL skeleton there are actually 741 entheses. Most are no bigger than a pencil lead some smaller a few bigger. Then think of the tendon stuffed into the little hole and how VERY VERY little inflammation it takes to put enough pressure to cause a lot of pain. Its amazing how the tiniest thing can cause so much grief. I remember the first kidney stone I passed. I swear to gosh I gave birth to a heifer calf. When they used those itsy bitsy tweezers to get it off the filter...... I was mortified and I really did know what a kidney stone was. My grandpa had one the size of a walnut on the mantle.