What is Enthesitis and How Does Does it Relate to Ankylosing Spondylitis?

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Enthesitis is where you have inflammation of what are known as the entheses.

These are the specific points where your tendons or ligaments attach to the bones.

Enthesitis is most commonly associated with inflammatory conditions such as ankylosing spondylitis and psoriatic arthritis.

However, it can also occur in other conditions like reactive arthritis and gout.

Enthesitis and ankylosing spondylitis

Ankylosing spondylitis (AS) primarily affects the spinal joints, sacroiliac joints, and other large joints.

Enthesitis often occurs in the ligaments and tendons that attach to the spine and pelvis. This includes the Achilles tendon, the plantar fascia, and the iliac crest.

(If you have ankylosing spondylitis you will likely be familiar with the sacroiliac joints).

Enthesitis is often one of the earliest features of AS, and can take place even before the onset of joint symptoms.

Inflammation at the entheses can lead to the formation of new bone, called syndesmophytes.

This can cause joint stiffness and fusion over time which results in that forward bending posture, sometimes associated with ankylosing spondylitis, known as kyphosis.


Kyphosis is where there is exaggerated curvature of the spine that causes a hunched back. It can lead to limited mobility of the spine and other affected joints.

How enthesitis is detected?

Enthesitis is usually detected through physical examination and imaging tests such as X-rays, ultrasounds, or MRI scans.

Sometimes blood tests are used to look for inflammation markers as well.

In a physical examination, doctors will look for signs of inflammation. This signs include swelling, tenderness, and heat at the site of attachment of the tendon or ligament to the bone.

X-rays, ultrasounds, and MRI scans can detect changes in the bone and soft tissue at the site of enthesitis.

X-rays can reveal bony spurs or erosions, while ultrasounds and MRI scans can detect soft tissue changes like fluid accumulation or thickening of the tendon or ligament.

Blood tests are typically used to look for inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

Should you be worried?

If you have been diagnosed with AS, enthesitis is a common symptom.

While it can be painful and disabling, it is treatable with medication and lifestyle changes.

One of the primary goals of this website to raise awareness about ankylosing spondylitis and ‘mystery back pain’. Early detection and treatment is SO important. It can help prevent the progression of the disease and vastly improve people’s quality of life.

If you have symptoms of enthesitis, such as pain, swelling, and tenderness in your joints, please see a doctor.

After you’ve talked them through your symptoms they may refer you to a rheumatologist, who specialises in the diagnosis and treatment of inflammatory conditions like ankylosing spondylitis.

I’ve included more information about how you can 🔗 get a diagnosis for ankylosing spondylitis here.

What you can do about it

Treating enthesitis depends on your underlying condition and the severity of your symptoms.

However, typically it can include medication physical therapy, and lifestyle changes such as regular exercise.

The focus of this website is looking at root cause and gut health to manage autoimmune conductions.

You can see more information about 🔗 using diet to manage autoimmune disease here.

Medication-wise the most common treatments in the first instance tend to be nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce pain and inflammation. Ibuprofen and naproxen are two well known examples.

In more severe cases, disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and sulfasalazine are prescribed to help slow the progression of the disease.

Finally, where more targeted treatments are needed, biologics such as tumor necrosis factor (TNF) inhibitors, interleukin-17 inhibitors, and interleukin-23 inhibitors are used. These are at the more advanced end of the medical interventions and target specific molecules involved in the inflammatory process.

Then there are the more natural approaches.

Physical therapy has long been proven to help improve joint mobility and reduce pain.

Physiotherapists and osteopaths can recommend exercises and stretches to help you strengthen the muscles and improve flexibility.

There are some 🔗 great exercises provided by the NASS which you can see here.

Spinal stretching, yoga and pilates prove extremely effective for many people.


Finally, there are lifestyle changes such as 🔗 diet and regular exercise, such as swimming or walking.

All of these can help improve joint mobility and reduce pain. Maintaining a healthy weight can also help reduce stress on the joints and improve your overall health.

You can see a more 🔗 detailed list of ankylosing spondylitis treatments here.

In most extreme cases of enthesitis, as a last resort, surgery may be necessary to repair or remove damaged tissue or bone.

This tends to be reserved for cases that have not responded to other forms of treatment.

I hope you found this helpful.

If you have anything to add, or any questions, please leave a comment below.

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