Enthesitis: Causes, Symptoms, and How It Connects to Arthritis and Chronic Pain

When you feel sharp pain at the bottom of your heel, the back of your knee, or even your elbow—especially after sitting still or waking up—it might not just be a strain. It could be enthesitis, inflammation at the site where tendons or ligaments connect to bone. Also known as enthesopathy, it’s a key feature in several autoimmune conditions, especially psoriatic arthritis and ankylosing spondylitis.

Unlike regular muscle soreness, enthesitis doesn’t go away with rest alone. It’s driven by the immune system attacking these attachment points, leading to swelling, stiffness, and sometimes even bone changes over time. People with psoriasis often develop it without realizing the two are linked. The same inflammation that causes scaly skin can also target the heel, Achilles tendon, or the spine’s ligaments. It’s not just about joints—it’s about the connective tissue holding them together. And if left unchecked, it can lead to long-term mobility issues, even in younger adults.

What makes enthesitis tricky is that it often shows up before full-blown arthritis does. That’s why many patients get misdiagnosed with plantar fasciitis or sports injuries. But if you’ve got persistent pain in those attachment zones—especially if you also have skin changes, fatigue, or family history of autoimmune disease—it’s worth asking about enthesitis. Treatment isn’t just about painkillers. It’s about targeting the root inflammation, often with biologics or NSAIDs, and pairing it with physical therapy to keep those tendons flexible. The good news? Early action can stop it from worsening.

Below, you’ll find real-world advice from people who’ve lived with this condition. You’ll see how medications like azathioprine and SGLT2 inhibitors can affect inflammation, how diet and exercise play a role in managing chronic pain, and how switching drugs or adjusting dosages can make a difference. Whether you’re dealing with heel pain, back stiffness, or unexplained joint discomfort, these posts give you the practical tools to understand what’s happening—and what to do next.