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enthesopathy

ICD-10 Codes

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Description

Enthesopathy refers to a disorder that affects the entheses, which are the connective tissues between bones and tendons or ligaments [5]. It occurs when these tissues have been damaged, due to overuse, injury, or infection [2]. Enthesopathy can also be caused by an inflammatory condition such as psoriatic arthritis [3].

The symptoms of enthesopathy may include pain and inflammation around the joints [3], and in some cases, it can feel like widespread joint pain [6]. The affected area may become ropey due to fibrosis, a process where tissues become scarred and stiff [4].

Enthesopathy can be caused by various factors, including:

  • Overuse: repetitive motions that damage a particular area of the body
  • Injury: trauma or sudden impact on the entheses
  • Infection: inflammation caused by an underlying condition such as psoriatic arthritis
  • Systemic inflammation related to arthritis [9]

The diagnosis and treatment of enthesopathy depend on the underlying cause. Healthcare providers may suggest treatments to manage symptoms, but in many cases, the underlying cause needs to be identified and treated [5].

Enthesopathy can affect various regions of the body, including the shoulder, elbow, wrist, carpus, hip, knee, ankle, tarsus, or heel bone [1]. It is essential to consult a healthcare provider for an accurate diagnosis and treatment plan.

References:

[1] Enthesopathies may take the form of spondyloarthropathies (joint diseases of the spine) such as ankylosing spondylitis, or psoriatic arthritis, plantar fasciitis, and Achilles tendinitis. [2] Enthesopathy occurs when these tissues have been damaged, due to overuse, injury or infection. [3] Enthesopathies may take the form of spondyloarthropathies (joint diseases of the spine) such as ankylosing spondylitis, or psoriatic arthritis, plantar fasciitis, and Achilles tendinitis. [4] The difference is that fibrous entheses insert directly onto the periosteum, whereas fibrocartilaginous enthesis lack periosteum. [5] Enthesopathy describes a problem or process at the site of a tendon or ligament attachment to bone. It can be the result of an inflammatory process and an inflammatory arthritis, such as reactive arthritis, ankylosing spondylitis, psoriatic arthritis, sarcoidosis, or gout. [6] A doctor who diagnoses a patient with enthesopathy will want to identify and treat the underlying cause. In many cases, the underlying cause is systemic (body-wide) inflammation related to arthritis. [7] Enthesopathy describes a problem or process at the site of a tendon or ligament attachment to bone. It can be the result of an inflammatory process and an inflammatory arthritis, such as reactive arthritis, ankylosing spondylitis, psoriatic arthritis, sarcoidosis, or gout. [8] Enthesopathy may be due to an inflammatory condition, such as psoriatic arthritis, or a condition related to injury or overload, such as plantar fasciitis.

Additional Characteristics

  • Infection
  • Overuse
  • Injury
  • Systemic inflammation related to arthritis

Signs and Symptoms

Enthesopathy, also known as enthesitis, can manifest in various ways, depending on the affected area and underlying cause. Here are some common signs and symptoms:

  • Pain and swelling: Pain and tenderness at the site where tendons or ligaments attach to bone are hallmark symptoms of enthesopathy [1].
  • Limited mobility: Inability to move a joint in the directions it's normally supposed to go, due to stiffness and inflammation [4].
  • Stiffness: Stiffening can occur at joints, especially after sleeping or sitting for extended periods [3][4].
  • Painful areas: Common spots for enthesitis include around the heel, knee, hip, toe, elbow, backbone, and the bottom of the foot [2].

In some cases, enthesopathy may be accompanied by other symptoms, such as:

  • Reduced range of motion: Children with enthesopathy of the hip and knee may experience reduced range of motion around the affected joint [9].
  • Soft tissue swelling: Swelling in the soft tissues surrounding the affected area can occur due to inflammation [6].

It's essential to note that these symptoms can vary depending on the individual case, and not everyone will exhibit all of them. If you're experiencing any of these symptoms, it's crucial to consult with a healthcare professional for proper diagnosis and treatment.

References: [1] - Context result 1 [2] - Context result 2 [3] - Context result 3 [4] - Context result 4 [6] - Context result 6 [9] - Context result 9

Additional Symptoms

  • Pain and swelling
  • Stiffness
  • Limited mobility
  • Reduced range of motion
  • Painful areas
  • Soft tissue swelling

Diagnostic Tests

Enthesopathy, also known as enthesitis, can be challenging to diagnose due to its non-specific clinical signs and symptoms.

Physical Examination A physical examination is the primary method for diagnosing enthesopathy. Your doctor will perform a thorough examination to check for swelling, tenderness, and pain in the affected area [1]. This examination may also involve checking for any deformities or abnormalities in the surrounding tissues.

Imaging Tests While there are no specific tests that can diagnose enthesopathy, imaging tests such as ultrasound, X-rays, or MRI scans may be used to rule out other conditions and confirm the diagnosis [2], [3]. These tests can help identify any injuries or damage to the tendons or surrounding tissues.

Laboratory Tests Laboratory tests are not typically used to diagnose enthesopathy. However, your doctor may use them to rule out other underlying conditions that may be causing your symptoms [4].

Additional Tests In some cases, additional tests such as blood tests or joint fluid analysis may be conducted to confirm the diagnosis and rule out any underlying conditions [5]. However, these tests are not specific to enthesopathy and should be used in conjunction with a physical examination.

It's essential to note that diagnosing enthesopathy can be challenging due to its non-specific clinical signs and symptoms. A healthcare professional will use a combination of the above methods to make an accurate diagnosis.

References: [1] Aug 16, 2024 — Enthesopathy Diagnosis​​ [2] Sep 17, 2024 — Diagnosing and Treating Enthesitis [3] by I Sudoł-Szopińska · 2015 · Cited by 70 — Clinical diagnosis of enthesitis is based on rather non-specific clinical signs and results of laboratory tests. [4] Jul 22, 2024 — Laboratory tests: ... Enthesitis and enthesopathy are diagnosed primarily through clinical history and examination, with imaging and laboratory ... [5] Aug 18, 2017 — A doctor can diagnose enthesopathy based on symptoms and an examination alone. When symptoms are unclear, or when another condition might be the ...

Additional Diagnostic Tests

  • Physical Examination
  • Imaging Tests (e.g., ultrasound, X-rays, MRI scans)
  • Laboratory Tests (not typically used for diagnosis)
  • Additional Tests (e.g., blood tests, joint fluid analysis)

Treatment

Enthesopathy, also known as enthesitis, is a condition characterized by inflammation and pain at the sites where tendons or ligaments attach to bones. The drug treatment for enthesopathy typically involves medications that help reduce pain and inflammation.

Medications Used

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be prescribed to relieve pain and swelling [1][2].
  • Disease-modifying antirheumatic drugs (DMARDs) may also be used in some cases, especially if the enthesopathy is associated with an underlying condition like psoriatic arthritis [5].
  • Corticosteroids, such as sulfasalazine (SSZ), may be prescribed to reduce inflammation and pain [7].

Treatment Response

With appropriate treatment, including NSAIDs and DMARDs, many people experience significant improvement in symptoms. In fact, studies have shown that up to 75% of patients with enthesopathy respond well to treatment [5].

Common Medications Prescribed

According to a study, the most commonly prescribed medications for nonsteroidal anti-inflammatory agents are:

  • NSAIDs: 25%
  • Glucocorticoids: 14%
  • Topical steroids: 12%
  • Narcotic analgesic combinations: 10%
  • Local injectable anesthetics: 8.3% [10]

It's essential to note that the specific treatment plan will depend on individual factors, such as the severity of symptoms and any underlying conditions.

References:

[1] Aug 16, 2024 — Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, may help relieve pain and swelling. But sometimes they might not be ...

[2] Treatment for enthesopathy includes treating any underlying causes, as well as anti-inflammatory medication to reduce pain and inflammation.

[5] Jul 22, 2024 — Treatment response: With appropriate treatment, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs ...

[7] by CT RITCHLIN · Cited by 73 — Ten publications were selected for this review of psoriatic enthesopathy. Details of these trials are outlined in Table 2. Sulfasalazine (SSZ).

[10] Result: | male | female | all nonsteroidal anti-inflammatory agents | 26% | 25% | 25% glucocorticoids | 11% | 17% | 14% topical steroids | 11% | 12% | 12% narcotic analgesic combinations | 7.2% | 14% | 10% local injectable anesthetics | 5% | 11% | 8.3%

Recommended Medications

  • Disease-modifying antirheumatic drugs (DMARDs)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
  • sulfasalazine
  • Sulfasalazine

💊 Drug information is sourced from ChEBI (Chemical Entities of Biological Interest) database. Always consult with a healthcare professional before starting any medication. Click on any medication name for detailed information.

Differential Diagnosis

Differential Diagnosis of Enthesopathy

Enthesopathy, also known as enthesitis, is a condition characterized by inflammation and pain at the sites where tendons or ligaments attach to bone. When diagnosing enthesopathy, it's essential to consider various differential diagnoses that may present with similar symptoms.

  • Other causes of periarticular pain: Conditions such as fracture, osteoarthritis, and rheumatoid arthritis can cause pain in the affected joint or area of the body, making them potential differential diagnoses for enthesopathy [9].
  • Infectious or postinfectious arthritides: Viral infections, rheumatic fever, post-streptococcal arthritis, and Lyme disease are all possible causes of joint pain that may be mistaken for enthesopathy [8].
  • Mechanical strain: Repetitive motion or overuse can lead to mechanical strain on tendons and ligaments, causing pain and inflammation similar to enthesopathy [2].
  • Other conditions: Enthesopathy may also be secondary to other conditions such as osteoarthritis, rheumatoid arthritis, or psoriatic arthritis [6].

Imaging examinations

In addition to clinical diagnosis, imaging examinations can help rule out other causes of pain and inflammation. Radiographs in the lateral view may show enthesophytes (osseous spurs), which are a characteristic feature of enthesopathy [10]. However, these findings should be interpreted in conjunction with clinical signs and laboratory results.

References

[1] I Sudoł-Szopińska · 2015 · Cited by 70 — Clinical diagnosis of enthesitis is based on rather non-specific clinical signs and results of laboratory tests. Imaging examinations are highly promising. [8] The differential diagnosis of JSpA includes true infectious or postinfectious arthritides (viral, rheumatic fever, post-streptococcal, Lyme). More benign conditions should also be considered. [9] Nov 5, 2014 — Differential Diagnosis: Other causes of periarticular pain, including fracture, should be considered (see Nonarticular Disorders). Therapy... [10] Feb 27, 2020 — Diagnosis is clinical. Radiographs in the lateral view may show enthesophytes (osseous spurs). Treatment is with stretching, splinting, and...

Additional Differential Diagnoses

Additional Information

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