So I’ve noticed through readings the threads that tendonitis and enthesis as a predominant symptom seems to be rather common (and my main complaint). My rheumy seems to only see joints – as in, if there’s no joint damage, it’s only a ‘mild’ case of PsA.
My question for those of you with more experience of this disease is this:
Does inflammation of the tendons /enthesis cause permanent damage? Should I be concerned about tendons rupturing, etc? Thanks in advance for helping me with this question that’s been bugging me for a while now…
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Hello there, thanks for raising this question, I’m in the same boat. My main problems (to me) are tendon based but as you say the specialists seem to brush off the tendon issues as unimportant. I can’t get an answer to the question either and I’ve been asking. I have a rheumatology appointment in a couple of weeks and I’m going to push for an answer this time, so I’ll pass the answer on to you. The only thing I can add is that I’ve had tendon issues for over 20 years and yes I get a lot of pain from them but other than having calcium deposits in some areas of tendon tissue and ‘lumps’ on sites I’ve not suffered extra damage of tendon rupture
Thanks Louise--I have the "lumps" also, they came on rather suddenly and early in my disease and never went away. Good to hear you don't seem to have any serious issues from the tendon issues (other than the pain!). Please do let me know what your rheumy says...
Definitely push the issue with your rheumy. Also, of all specialists a rheumy shouldn't brush off tendon issues since they can be part of the disease. I can see an orthopedist not connecting the dots between tendinopathy and psa but a rheumy should know better.
Yes the inflammtion on the tendons can cause permant damage. When the inflammed tendon doesn’t allow for the joint to move properly it will cause the joints to break down and cause joint damage, as for the tendon it self, it can cause scar tissue which will keep the tendon from gliding, causing more damage.
Thanks Shutterbug, I was afraid of that! I will definitely be following up with my Rheumy next appt, as my tendon/enthesis issues are not mild!
Anyone else have experience with this? Anyone have tendon/enthesis issues beyond pain (rupture, etc)?
First of all its Enthesitis..... I'm not splitting hairs its important. The Entheses are sites of tendinous or ligamentous attachments to the bone. In short they are a part of the "joint" (or in the case of hands - the join) Enthesitis is inflamation of that part of the joint. These are not separate or different conditions/diseases. This is the way PsA works.
The "damage" with mutilans its rapid and nasty, with spondylitis its the spine. With the other forms its not so rapid...
I'm not thinking its a good idea to tell your Rheumy they aren't treating these things if they are treating your disease at all....... Early the disease these effects can be confused as something else.in (we won't report the Hernia stories again - there are several of them bouncing around here) What we are talking about is not something new and different to make us hurt, but rather one of the primary ways PsA does it. I will tell you when the whole tendon gets inflammed, its bad, and lasts a long while. and the primary treatment is PT. its really hard to know if your meds are helping, because until you get the tendon moving and circulation going the inflamation won't go away and WORSE the common pain meds will make the situation worse.
Try this video: http://www.youtube.com/watch?v=xtOLGIm1hhU
I just developed enthesitis 2 months ago... full body. It's pretty darn horrible! I had to add Arava into the mix and it helped tremendously (Arava is a cousin to MTX, I can't tolerate MTX but can tolerate the Arava). I've been assuming it is similar to joints - keeping inflammation down keeps damage down.
Thanks tntlamb -- didn't realize the entheses are part of the joint. I think my main problem is tendons (feet) and the meds (NSAIDS) don't seem to be helping. Perhaps I need to get off my butt and give them some exercise...
The right exercise Mamma, the wrong will make it worse. Try rolling a coke bottle filled with water and frozen r back and forth under your feet for pain relief
I too have also been diagnosed with tendinitis several times and all over the place. I wonder does anyone else have more info on this?
Is it possible that you were misdiagnosed at those times? I was diagnosed with all sorts of the wrong things, including tendonitis, prior to seeing a specialist.
SublimeAmiga said:
I too have also been diagnosed with tendinitis several times and all over the place. I wonder does anyone else have more info on this?
Yes, I have the same problem. I just mentioned it to my doc during my last appointment. I asked the doc if this was that should be noted and he did note it.
I have had PsA for a few years at least, it was only diagnosed last year. I typically don't get pain in my joints but the damage is the same. For me the tendons cause the most misery. It's frustrating because I find if I don't have a sausage finger the doc doesn't give me a shot. Lately I have one finger that swells up several times a week on and off but still no shot. Waiting for the new meds to kick in just takes too long.
Oh yes of course! That is why I am here I am finally getting diagnosed with PsA and it took them about 8 years to figure it out lol
GrumpyCat said:
Is it possible that you were misdiagnosed at those times? I was diagnosed with all sorts of the wrong things, including tendonitis, prior to seeing a specialist.
SublimeAmiga said:I too have also been diagnosed with tendinitis several times and all over the place. I wonder does anyone else have more info on this?
Are coritisone shots good for us? I thought anything with steroids just causes us to flare up after it wears off?
Dini said:
Yes, I have the same problem. I just mentioned it to my doc during my last appointment. I asked the doc if this was that should be noted and he did note it.
I have had PsA for a few years at least, it was only diagnosed last year. I typically don't get pain in my joints but the damage is the same. For me the tendons cause the most misery. It's frustrating because I find if I don't have a sausage finger the doc doesn't give me a shot. Lately I have one finger that swells up several times a week on and off but still no shot. Waiting for the new meds to kick in just takes too long.
Enthesitis or inflammation at sites of ligament, tendon or joint capsule insertion is a main feature of PsA AND YES it is a form of "Tendonitis" and the damage can be permannet (Tendonitis is a term like flu BTW)
There are two ways to measure it. The Mander Index is an assessment of tenderness at 66 sites and is generally thought to be too cumbersome for routine use so they came up Modified Mander is based on tenderness at 17 sites and the degree of tenderness at each enthesis on a scale of 1–4. Then they came up with yeta another one because the modified mander seemed to be wrong 22% of the time (I vhave a study somewhere)
The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) is calculated based on the presence or absence of tenderness at 13 sites and is most commonly used. Its NEW. New docs seem understand it. The guys that have been around awhile, not so much. There is a problem and all of us especially women should be very aware of it.
Those sites (and even on the Modified Mander) also line up almost perfectly the Fibromyalgia Tenderpoints used for diagnosing that disease. Consequently we have a lot of folks (usually women) running a round also tagged with a fibro Dx who really have PsA. there are a few the other way. The caution here is and hopefully SK will drop by to help out is that the diseases are treated completely differently (and they should be)
If you get hung with a wrong PsA Dx it doesn't have near the effect a Fibro (in Error) Dx does. It is not right, there are still lrge numbers of physicians pout there who believe Fibro is largley an emotional disorder and pain management becomes very inconsistent. Also pain management will in most cases mitigate the "pain" from PsA. So it looks like its working. The damage however is still occuring.
I know there are several here that have had an experience are in the middle of the changing diagnoses thing and all the rest (including dual Diagnoses) I would love to see you start a thread to share your exoperiences. I think it has a lot of relevence and importance.
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Do you know what they are talking about here http://en.wikipedia.org/wiki/Tendinitis when they are saying if we have Tendinitis for a long period of time it can be Tendonosis? This pretty much describes my pain:
Diagnosis[edit source | editbeta]
Symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms. If the symptoms of tendinitis last for several months or longer it is probably tendinosis.
Also, here is a little bit more info on everything I went through...
The very first time I got hurt, I didn't know what PsA was. I had the skin disease since I was a kid and I was working at Steak N Shake making shakes for 12 hours. I couldn't use the full range of my arm the next day and they put a cortisone shot in my shoulder blade. It was horrible. I was sent to PT and then I was fine. After that I didn't have that much pain for a while. Oh I also had a pain so bad in my shoulder that one day I woke up and couldn't turn my neck and my doctor had to give me a flexeril to make it go away. Then I started having wrist pain. I thought it was due to typing... I do use the computer a lot and I was in Graphic Design (for college) so that kinda made sense. I did PT again and it went away. Both times I was told it was Tendinitis. I didn't think much of it because I had a reason for each pain. Then I had pain in my knees and it was crazy how much and how fast it hit me. I was sent to an Orthopedic Surgeon. They did Xrays and MRIs and thought I was crazy because they found nothing. My doctor drew labs and found no inflammation. So the Orthopedic Surgeon came up with a BS theory that my legs were not straight and made me wear huge leg braces for 3 months. My pain became unbearable and it was due to the stupid braces. My doctor had me up to 1000mg of Naproxen for my pain and then it hit me and I was in unbearable agony with my stomach. I couldn't eat without pain. I couldn't even drink water. I was nauseous and miserable at work. I would be in so much pain I could no longer stand because I had she sharp pains and contractions in my stomach. I would feel all feverish and almost throw up. The doctor finally ordered a colonoscopy and they found a huge big red sore in my stomach. It was Gastritis from the Naproxen. I went to a 2nd doctor to get a new opinion on everything and immediately stopped taking NSAIDS and got rid of the leg braces because my legs were in fact straight! I went back to PT and then I was fine. It's crazy how PT fixes everything. If only I had kept up on my exercises. Several other times I had "flares" in my knees, wrist, and shoulder... I started to wonder what the heck why would I be prone to tendinitis so much??? And that's when I found out about Psoriatic Arthritis. I was in shock that none of these doctors ever put 2 and 2 together. When my husband got out of the army I was without health insurance for a while and up to even now. BUT I have been going to a great place that allows me to pay on a sliding scale and I only pay $15 to see a doctor. Labs are free there too. She has been working with me since 11/2011 but, slowly.
I was in a major car wreck in 4/2012. I was driving to work on a country road and the speed limit there is 55mph. Someone had a stop sign but, it's not unusual for them to drive through it.. only she didn't see my car! She pulled out right in front of me and I swerved not to slam into her and my car flipped over 5 times. I actually didn't break a bone! I was bleeding a lot because I hit my head on the roof so much. I had whiplash of my entire body. I couldn't walk or sit up the next day. My husband had to help me for a week. I was on bed rest for 2 weeks. I went to PT for 2 months and I did a lot of things at home on my own to build back strength. It took a lot out of me and I was also in my finals for my Associate of Arts in Human Services, I was doing an internship and trying to get my life back all at the same time. My inflammation was the highest I have ever seen it. I finally went back to work 6/2012
Upon finishing this degree I went to work for a company in direct care with individuals that are developmentally disabled in group homes. I worked there for year and I noticed my pain in my knees were coming back, then my shoulder, and then my wrist. I didn't think it was that serious. I tried everything I had learned from PT and it would help but, it was lingering and playing musical joints.
About a few months ago, I had a really bad flare up I guess we will call it... I didn't know what a flare up was with PsA until I came here... but like I said I had a flare up and it was so bad I could not use my wrist at all. It started small... We went on vacation and I noticed when I wanted to do my word search I couldn't circle the words because my wrist was twitching a lot. I could feel it twitching on it's own and I was not controlling that. Then I worked in my garden a few different times and I noticed my wrist was in agony afterwards. I would ice it and then heat it to help. It worked for a little while. Then the pain got unbearable. I was in tears. I didn't know what the heck was going on. I went to the doctor and she said after everything I have told her she believes I have PsA. First though she wanted to make sure it wasn't carpel tunnel so she had an EMG ordered and my nerves are all working great and I am very healthy. Even my blood was drawn and my labs all came back healthy. I have great blood pressure too.
So she attempted Celebrex for the pain but, it hurt too much. I didn't know if it would be easier on my stomach but, she wanted to try it before we had to take the next step. I waited for months to hear back about where I could go without insurance. She finally found me a clinic 2 hours away that bases everything off income and I should be paid for 100% when I do the paperwork with them. My appointment is in September and I can't wait to go! :-) This is my first time ever being referred to a Rheumatologist.
jenn you're dealing with some basic medical terminology (we should add it to the glossary Tendinitis and Tendinosis are exactly the same thing. but the medical folks always want to make it difficult. If it ends in "itis" it means it short term or the medical way "acute" if its "osis" it means long term or the medical way "chronic"
Way back when I was in medical school (I graduated but I am not a physician) I can remember a prof really reaming someone for using the term "chronic tendonitis" instead of the correct tendonosis. The prof was screaming tell me the difference..... The student said $20.00 as a specialist and the patient will feel better. The proff stopped though and said point taken. Chronic is more comforting than osis. perhaps because the only osis most of us hear is Psychosis.
You will have a great appointment but start a list NOW. If you can put your concerns in an outline type form. This is the way docs think.
oh ok, I would have never understood that! Thank you! I also would never think to put anything in an outline to take to my doctor. I will attempt to do it and see what I can come up with.
tntlamb said:
jenn you're dealing with some basic medical terminology (we should add it to the glossary Tendinitis and Tendinosis are exactly the same thing. but the medical folks always want to make it difficult. If it ends in "itis" it means it short term or the medical way "acute" if its "osis" it means long term or the medical way "chronic"
Way back when I was in medical school (I graduated but I am not a physician) I can remember a prof really reaming someone for using the term "chronic tendonitis" instead of the correct tendonosis. The prof was screaming tell me the difference..... The student said $20.00 as a specialist and the patient will feel better. The proff stopped though and said point taken. Chronic is more comforting than osis. perhaps because the only osis most of us hear is Psychosis.
You will have a great appointment but start a list NOW. If you can put your concerns in an outline type form. This is the way docs think.
Yes! The inflammation leads to bone spurs.
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