Enthesitis is inflammation of the 'enthesis,' which is where a tendon or ligament attaches to bone, says Joan Appleyard, MD, a rheumatologist at Baylor College of Medicine in Houston, Texas. Symptoms are pain sometimes accompanied by swelling. There's a reason the enthesis is susceptible to this problem Enthesitis and the feet Enthesitis can impact one heel or both as well as other body parts. It can occur in most places we hurt, but common locations for people with ankylosing spondylitis include 1 Tibialis anterior enthesitis may manifest as ankle pain and swelling on the top of the foot. Enthesitis of the small intrinsic muscles of the foot or the small ligaments in the foot is much harder to recognise. It may also manifest as soft tissue swelling or bone pain. Functional Enthesis or wrap around tendon pai
But one of the most common targets in PsA is the enthesis where the Achilles tendon attaches to the back of the heel, which can make every footstep a painful experience. Another common symptom of PsA is just another sign of enthesitis, says Dr. Bykerk When enthesitis occurs at the arch of the foot, it is called plantar fasciitis. Enthesitis at the heel is called Achilles tendonitis. Finally, the nails of the toes can become affected by psoriatic arthritis, causing pitting, thickening, lifting of the nail from the nail bed, and pain. 1,2 Psoriatic arthritis foot pai Foot and ankle abnormalities, including joint inflammation and enthesitis, occur in up to 70 percent of people with PsA. They might be the first symptom of the disease — occurring before any significant joint symptoms Enthesitis can also cause pain on the soles of your feet. The plantar fascia is a sheet of connective tissue on the bottom of the foot that attaches your heel to the front of your foot. It runs..
Foot pain is a common component of Ankylosing Spondylitis (AS) & other seronegative spondyloarthropathies (SpA- psoriatic arthritis, reactive arthritis). In AS/ SpA, the inflammation is predominantly at two locations- within the joints- synovitis & at the attachment of ligaments/ tendons to a bone (enthesitis) Let us have a look at the various causes of foot The common manifestations of AS and peripheral spondyloarthritis are arthritis and enthesitis, which are believed to contribute to abnormal foot posture. Gokcen and colleagues found that 39% of patients with AS had foot involvement The main symptom of plantar fasciitis is pain in the arch of your foot. It's usually localized at the sole of your foot, but the pain can be perceived as radiating throughout parts of your foot, ankle, and lower leg. That means plantar fasciitis might be confused with other conditions affecting your foot Typically the joints of the knees, feet, and ankles are targets for inflammation secondary to reactive arthritis. More specifically, enthesitis in people with reactive arthritis usually occurs in the plantar fascia, pelvic bones or Achilles tendon Enthesopathy can develop at any joint or area where tendons or ligaments attach and may cause pain near several different joints. The heel, knees, hips, fingers, toes, elbows, and backbone are..
Enthesitis and foot posture were evaluated by the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and Foot Posture Index-6, respectively. Results Patients with AS revealed significantly higher scores of foot posture index when compared with controls ( P = 0.005) Enthesitis and foot posture were evaluated by the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and Foot Posture Index-6, respectively. RESULTS Patients with AS revealed significantly higher scores of foot posture index when compared with controls (P = 0.005) What causes enthesitis? Overuse (like repetitive motion), injury (traumatic or from sports) or diseases, such as psoriatic arthritis or ankylosing spondylitis, are the most common causes. Pain is typically felt in areas such as the heel, bottom of the foot, hip, knee, toes, or spine, but it can happen anywhere there is an attachment point. Background/Purpose: Though foot involvement is common in juvenile idiopathic arthritis (JIA), it is often neglected by patients and physicians alike. The involvement could occur due to arthritis, enthesitis or tenosynovitis. Tarsitis is thought to be a harbinger for spondyloarthropathy. Thus this study was done to assess clinical and radiological involvement of feet as well as its [ Background Enthesitis is a primary clinical feature of ankylosing spondylitis (AS). Lower extremity enthesopathy may cause foot pain and functional disability. Detection of enthesitis by using physical examination may be insufficient. Musculoskeletal ultrasonography is a noninvasive and low-cost method for detecting enthesitis readily. Objectives The aims of this study were to evaluate.
The enthesis is the point at which the connective tissue structures, such as a joint capsule, fascia, ligament, tendon, or muscle attach to the bone. The term enthesopathy typically refers to a degenerated enthesis; though when some doctors uses this term, they typically mean enthesitis (inflammation of the enthesis) Enthesitis usually does not cause swelling of the joint. On physical examination, tenderness is found on the bony sides of the joints, away from the joint line. Iagnocco T, et al. Ultrasound evaluation of hand, wrist and foot joint synovitis in systemic lupus erythematosus. Rheumatology (Oxford, England) 2014;53:465-472 As a result, children with enthesitis report heel, foot or knee pain, with or without swelling. To help with enthesitis pain in the foot and heel, your child's health-care team may recommend supportive footwear and padded heel inserts for your child's shoes.</p><p>Symptoms of ERA can come and go Enthesitis. Enthesitis is painful inflammation where a bone is joined to a tendon (a tough cord of tissue that connects muscles to bones) or a ligament (a band of tissue that connects bones to bones). Common sites for enthesitis are: at the top of the shin bone ; behind the heel (Achilles tendon) under the heel ; where the ribs join the breast bon Enthesitis (rare plural: enthesitides) refers to inflammation of the enthesis (the attachment of ligament or tendon to bone).. Enthesitis may be the result of repetitive mechanical stress or a more generalized inflammatory condition. Enthesitis is associated with the HLA-B27 inflammatory arthritides such as ankylosing spondylitis, psoriatic arthritis and reactive arthritis, as well as juvenile.
Background: Musculoskeletal findings in Sjögren's syndrome are arthralgia, arthritis, myalgia, myositis, fibromyalgia, and chronic fatigue. Enthesis zones are important in the formation of pain in the musculoskeletal system. Musculoskeletal ultrasound (US) may show subclinical enthesitis in the synovial joints and in the axial skeleton before joint swelling in inflammatory diseases. Several enthesitis scoring measures have been developed, some originally developed in patients with ankylosing spondylitis (AS). All involve a standard palpation approach, i.e., applying ∼4 kg/cm 2 of pressure (enough to blanch the tip of the examiner's fingernail) and ascertaining the presence/absence and, in some indices, severity of. The causes of enthesopathy are broad. It may be localized and secondary to repetitive mechanical strain, or secondary to another condition which may be confined to a single system, or multisystem 1. Enthesopathy can incorporate 2: tendinopathy. bursitis. cyst-like erosions Achilles tendon enthesopathy is pain where the Achilles tendon attaches to the back of the heel bone. People typically feel pain at the back of the heel when walking. Diagnosis includes an examination of the tendon. Stretching, night splints, and heel lifts may help. (See also Overview of Foot Problems .
Common spots include at the back of the heel and the bottom of the foot. This is called enthesitis. Many people with psoriatic arthritis get very tired (fatigue) and some may have a low-grade fever. Symptoms may come and go. A period of increased inflammation and worsening of other symptoms is called a flare Noun. (anatomy) The point at which a tendon, ligament, or muscle inserts into a bone. Like arthritis, peripheral enthesitis occurs predominantly in the lower extremities, particularly in the foot, at single sites at onset, and then at several entheses throughout the course of the disease. Functional entheses occur where tendinous and.
. Entheses—the sites of attachment of ligament, tendon, fascia, or capsule to bone—are characteristic sites of inflammation, especially in the lower limbs, that occurs in 60% to 80% of ERA and JAS patients. Consequently, many patients with ERA complain of knee, foot, or heel pain Enthesitis is a relatively common symptom of psoriatic arthritis. In fact, it is one of the four main signs of psoriatic arthritis. The others include: Peripheral arthritis, which affects large and small joints in the hips, knees, wrists, elbows, feet, ankles. Spondylitis, which stems from inflammation of the spinal or sacroiliac joints, or. Clinical symptoms of enthesitis include tenderness, soreness, and pain at entheses on palpation. Common spots for enthesitis to happen are around your heel, knee, hip, toe, elbow, backbone, and the bottom of your foot. The inflammation can lead to pain and stiffness, especially when you're moving. You also might notice swelling around those. Approximately 35%-50% of patients with PsA may have enthesitis—inflammation of the tendons, ligaments, or joint capsule fiber insertion into the bone—that can result in pain at the back of the heel, sole of the foot, around the elbows, or in other areas
Objective To compare the Heel Enthesitis MRI Scoring model (HEMRIS) with clinical and PET/CT outcomes in patients with cutaneous psoriasis (Pso), psoriatic arthritis (PsA) or ankylosing spondylitis (AS). Methods This prospective, observational study included 38 patients with Pso, PsA and AS. Patients were included regardless of presence or absence of clinical heel enthesitis Inflammatory Arthritis: this can an affect any joint in the ankle or foot with inflammatory symptoms and signs (swelling or restricted mid-foot). Inflammatory arthritis (Enthesitis Related Arthritis) needs to be considered; enthesitis is very localised pain over an enthesis (e.g., the tendon insertion of the Achilles tendon into the calcaneum. In a person with psoriatic arthritis, enthesitis often affects the heel of the. foot. It also commonly affects the elbows, shoulders, hips, and knees, though the symptoms can occur around nearly. Enthesitis and my Podiatrist visit. Yesterday I went to the podiatrist for the second time to treat my foot and achilles tendon pain. I tried a local doctor and he was excellent. I have Ankylosing Spondylitis so i see my fair share of physicians, and there has been a wide range of competency and caring. This guy was a winner
. 8 19 Recently, the Outcome Measures in Rheumatology (OMERACT)-group developed and validated the Heel Enthesitis MRI Scoring system (HEMRIS. This list was then reviewed independently by a rheumatologist and orthopaedic surgeon, where consensus was established on which codes would properly capture tendinopathy or enthesopathy specific to the foot and ankle. While enthesitis is the more common outcome for patients with psoriatic arthritis, tendinopathy was included to broaden our. Enthesitis. Enthesitis, another cardinal extra-articular manifestation of PsA, is defined by inflammation at the sites where tendons, ligaments, and joint capsules attach into bone. The most commonly involved sites are the Achilles tendon and plantar fascia. It can also involve a lot of other areas and can lead to misdiagnosis as a result
Description. Enthesitis-related arthritis is diagnosed when rheumatoid arthritis affects the entheses, the connective tissue between a tendon or ligament and a bone. Ethesitis affects about 15% of patients with juvenile arthritis Enthesopathy, unspecified. M77.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2021 edition of ICD-10-CM M77.9 became effective on October 1, 2020. This is the American ICD-10-CM version of M77.9 - other international versions of ICD-10 M77.9 may differ I am waiting to see a Rheumatologist, as appointments in my area are booked up over two months in advance. For 2 months, in the evening I have acute tendon pain (unilateral, each night somewhere different.) Wrist, thumb, knee, foot, shoulder, elbow. By morning it is always gone. All of my bloodwork came back normal--no to Lyme's, 3 negative RA tests, no gout, no increased sed rate or sign of.
Like arthritis, peripheral enthesitis occurs predominantly in the lower extremities, particularly in the foot, at single sites at onset, and then at several entheses throughout the course of the disease. 2007, Philip Helliwell, James Woodburn, The Foot And Ankle in Rheumatoid Arthritis: A Comprehensive Guide, page 64 Other enthesopathy of left foot and ankle. M77.52 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2021 edition of ICD-10-CM M77.52 became effective on October 1, 2020
A joint is the space where two bones come together, such as an elbow or knee. Arthritis means this space becomes swollen and full of fluid. This can cause pain, stiffness and make it feel like your joints cannot move as well. The E in ERA stands for enthesitis Roughly 17% scored between 13 and 18 on the PDQ, indicating a substantial burden of neuropathic pain. Of the variables examined, the only statistically significant correlation with neuropathic pain in the patients studied was the presence of fibromyalgia syndrome (FM). FM was diagnosed in 30 of the participants (25%), 28 (93%) of which were women Enthesitis is a key feature of axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), and pain at entheseal sites is a key clinical sign .Enthesitis can occur at many sites in patients with SpA, but the heel (Achilles and plantar fascia insertions) is affected most frequently [2, 3].Although enthesitis is usually clinically assessed by scores like Leeds Enthesitis Index (LEI. Enthesitis was defined as discretely localized tenderness at the point of insertion of ligaments, tendon, joint capsules, or fascia to bone , and assessed according to the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), but including in additional plantar fascia and calcaneus enthesis ; (5) middle foot involvement, mono or bilateral. Objective. This case-control study was designed to evaluate magnetic resonance imaging (MRI) findings of knee joints in patients with psoriasis without clinical peripheral or axial joint involvement, and to correlate MRI findings with disease and demographic variables. Methods. In total 48 patients with psoriasis and no clinical evidence of synovitis or enthesitis in any peripheral or axial.
Enthesitis Assessment Before and After Anti-Tumor Necrosis Factor Treatment in Spondyloarthritis. July 10, 2021 checkorphan. - Demyelinating diseases, - Systemic lupus erythematosus, - History of knee, elbow, foot and ankle surgery, - Fluoroquinolone, retinoid and fluoride use, - Local corticosteroid injection at the examination sites. Enthesitis usually occurs in areas around your knee, elbow, hip, toes, fingertips, backbone and bottom of the foot. You are highly likely to notice swelling near the above mentioned areas. You will feel pain and stiffness when moving around
Achilles tendonitis is the most common type of enthesitis (inflammation of the entheses, the site where tendons and ligaments connect to bone).. The Achilles tendon connects the base of your calf muscles to your heel bone at the back of the leg. Symptoms of Achilles tendonitis include heel pain, tenderness and stiffness at the back of the heel . 22,24. A brief training is enough to put the LEI to use. A manual examination of 6 points can significantly improve clinical assessments of enthesitis 24: • Left and right lateral epicondyle. • Left and right medial femoral condyle Biomechanical factors, including foot function, may contribute to the development of enthesopathies (Benjamin & McGonagle 2001) and may help explain the discordance between disease activity parameters and enthesitis. It has been suggested poor alignment of the rearfoot and control of foot pronation, may make the enthesis at the heel more.
imaging modality to assess the enthesitis. Lehtinen et al12 and Balint et al13 first described sonographic features in limb enthesitis, showing a high frequency of asymptomatic abnormal findings. The abnormalities include loss of normal fibrillary echogenicity, with increased thickness or intralesional focal changes at tendon insertion Enthesitis is inflammation of an area where a tendon or ligament connects to bone. If it happens in the foot, it can be misdiagnosed as plantar fasciitis or heel spur, both of which tend to arise. Achilles Tendinitis, also known as Achilles Insertional Calcific Tendinosis (ACIT), is a condition caused by the deterioration of the Achilles tendon in the heel, resulting in bone spurs. If you're experiencing pain, contact FOI today to schedule an appointment
It is this pronation that squeezes the nerves on the inside of the ankle resulting in your symptoms. So, the more you walk, the more you pronate, the more pressure you put on the tibial nerve, the more pain you get on the ball of your feet. The second reason is that the pain from diabetic neuropathy is not dependent on any activity Introduction. Acquired flat foot is a relatively common deformity encountered in the adult population. It can be defined as partial or complete loss or collapse of the medial longitudinal arch. Adult acquired flat foot can have a varied presentation. It is occasionally an asymptomatic incidental finding on clinical examination Enthesitis (inflammation at the attachment of tendons, ligaments and fascia to bone with characteristic pain on palpation) around the foot may be confused with Sever's disease or plantar fascitiis. Enthesitis is usually associated with arthritis and symptoms are more prominent in the morning, which helps to differentiate it from the. Enthesitis and enthesopathy are both conditions that influence the entheses, or the spots where tendons or ligaments are attached to the bone. Enthesopathy relates to any rare condition that influences the entheses, while enthesitis is a condition in which the entheses become swollen or inflamed
Enthesopathy. An enthesopathy refers to a disorder involving the attachment of a tendon or ligament to a bone. This site of attachment is known as the enthesis (pl. entheses) . If the condition is known to be inflammatory, it can more precisely be called an enthesitis analyse foot MRIs . ACHILLES (NCT02771210) focuses on heel enthesitis in SpA, investigating clinical and imaging heel enthesitis endpoints. In the absence of a validated MRI scoring system for the heel at the time of study initiation, the ACHILLES trial used PsAMRIS with adaptations for heel enthesitis to assess MR images The peroneus brevis courses down the outside of your foot starting from the outside of your leg. It continues down the outside of your ankle to the outside bottom of your foot. The muscle and tendon is responsible for turning your foot up and out. If there is overuse of this motion, the tendon can become irritated and lead to pain over time
Enthesitis is inflammation of the sites where tendons or ligaments insert into the bone. It happens in many areas of the body including your heel, knee, hip, toe, elbow, backbone, and the bottom of your foot. In my case, it is affecting my elbows, wrists, and fingers , which in turn, affects my use of my hands and arms AS and enthesitis 10 years ago diagnosed with very mild ulcerative colitis and only 2 years ago with AS. Started humira immediately and was doing good till now. 6 months ago I observed a small growth on both foot, didn't gave it much thought but recently started feeling pain after standing or walking for 30mins or more
Our patient was HLA-B27+ and had enthesitis of the infrapatellar and Achilles tendon insertions and tarsitis of the foot. He was started on methotrexate and naproxen. At the 12-week follow-up, his ankle, foot, and knee pain had resolved. Six months later he developed lower back pain and elevated C-reactive protein The most common symptoms leading to an ultrasound examination of the posterior ankle region are those associated with disorders of the Achilles tendon or the plantar aponeurosis (heel pain and/or swelling). In an acute setting, ultrasound is most often performed for suspicion of Achilles tendon tear. Other common acute and chronic indications. When I had Fifth Disease 6-1/2 years ago, I experienced first hand (and first hip, first foot, first knee... :) ) what I think is the slam dunk symptom for enthesitis, which is pain with one direction of movement and not the reverse. When you have a joint, you have at least two separate muscles to move it In addition, supinated foot posture was associated with enthesitis of the Achilles tendon (P = 0.002). Conclusion: Enthesitis is related to deteriorated static foot posture in patients with AS
Spondyloarthropathy syndromes are characterised by axial arthritis (which affects the lower back) or peripheral arthritis (which affects the wrists, ankles, knees, and elbows). Patients generally complain of inflammatory back pain in the spine or sacroiliac joints (which connect the spine, hips, and sacrum) Enthesitis. Enthesitis is inflammation of the 'enthesis,' which is where a tendon or ligament attaches to bone, Symptoms are pain sometimes accompanied by swelling, Enthesitis is actually one of the hallmark traits of SpA. Common spots for enthesitis to happen are around your heel, knee, hip, toe, elbow, backbone, and the bottom of your foot Furthermore, MRI studies have also shown that extensive osteitis sometimes accompanies peripheral enthesitis, such as enthesitis adjacent to the plantar fascia, in patients with peripheral SpA 60. The most common areas affected by enthesitis are the knees, heels and bottom of the feet. As a result, children with enthesitis report heel, foot or knee pain, with or without swelling. To help with enthesitis pain in the foot and heel, your child's health-care team may recommend supportive footwear and padded heel inserts for your child's shoes
The primary endpoint was the proportion of pts achieving resolution of Achilles tendon enthesitis at the affected foot (assessed by the respective subcomponent of Leeds Enthesitis Index, LEI) with SEC vs PBO at Wk 24. Assessments at Wks 24 and 52 included LEI, heel pain (by NRS [0-10]), physician's and pt's heel enthesopathy activity and. Entheses are sites of tendon and ligament attachment to bone, and enthesopathy is a disease process occurring at these sites. It may be inflammatory, degenerative, endocrine, metabolic, or traumatic in nature. Common sites of involvement include the pelvis, femoral trochanter, humeral tuberosity, patella, olecranon, and calcaneus as well as. with a key role for enthesitis (38). Enthesitis points towards a unified biomechancial concept The presence of fibrocartilage at the enthesis points to complex compres-sive, tension and shearing forces (Fig. 1) (39). Fibrocartilage also is present where tendons wrap around bony pul-leys especially in the ankle and foot
• Option - assess for hypermobility, thigh-foot angle, enthesitis, muscle power, capillaroscopy With the patient standing: • Look at the forefoot, mid-foot (foot arch) and the hindfoot • Assess gait cycle (heel strike, stance, toe off), running and turning, ancillary movement • Assess muscle bulk (calves) Examination of the spin Psoriatic arthritis in the foot The ankle is a hinge joint between the talus bone of the foot and the two bones of the lower leg, the tibia and fibula. The ankle joint lets you move your foot up and down. Other movements, such as tilting and rotation, occur at other joints in the foot itself. Each foot contains 26 bones which form joints where. Bone marrow edema with several foci of high signal in multiple ankle and foot bones, coined high turnover, is commonly seen in children younger than 15 years . The cause of this asymptomatic and self-limited process is likely multifactorial, reflecting residual red marrow, hyperemia, increased bone remodeling, or altered weight bearing. In normal individuals, lateral radiographs show the thickness of the Achilles tendon to be not greater than 8 mm; the retrocalcaneal bursa creates a radiolucency which extends at least 2 mm below the superior surface of the calcaneus. In patients with any of these 4 articular disorders, Achilles tendinitis produces thickening of the tendon, and. Enthesitis is inflammation of this insertion point. Metatarsal heads on the base of the foot . Juvenile Psoriatic Arthritis. Psoriatic arthritis is an seronegative inflammatory arthritis associated with psoriasis, the skin condition. The pattern of joint involvement varies
Enthesitis Can Cause Pain and Swelling in the Feet iStock People with psoriatic arthritis often develop enthesitis — swelling, tenderness, or pain caused by inflammation in areas where tendons. Enthesitis is present in 35% of patients with PsA, and dactylitis occurs in approximately 50% of patients with PsA [10, 16,17,18]. Peripheral enthesitis, dactylitis, or both can be present in isolation for months to years in a small number of patients . Although the differential diagnosis of dactylitis includes several diseases, PsA is a common.
Enthesitis, inflammation of the enthesis (the site where a tendon or ligament attaches to the bone), is the second most frequent manifestation in children with SpA-ERA. Commonly affected entheses are located at the heel, in the mid-foot and around the kneecap. Most common symptoms include heel pain, mid-foot swelling and pain and kneecap pain Enthesitis: Inflammation of the connective tissue at the site where tendons or ligaments insert in the bone. Scientists originally found that the increase in this inflammation, called enthesitis, did not correlate with how long a patient had been on the gluten-free diet or results of tissue transglutaminase tests (tTG), which measure antibodies. Over the past decade, the assessment of the disease activity in psoriatic arthritis (PsA) has rapidly evolved in view of the need for valid, feasible, and reliable outcome measures that can be ideally employed in longitudinal cohorts, clinical trials, and clinical practice as well as the growing paradigm of tight disease control and treating to target in the management of PsA Weiss PF, Beukelman T, Schanberg LE, et al. Enthesitis-related arthritis is associated with higher pain intensity and poorer health status in comparison with other categories of juvenile idiopathic arthritis: the Childhood Arthritis and Rheumatology Research Alliance Registry. J Rheumatol. 2012;39:2341-51
enthesitis: ( en-thĕ-sī'tis ), Condition occurring at the insertion of muscles where recurring concentration of muscle stress provokes inflammation with a strong tendency toward fibrosis and calcification. [G. enthetos, implanted, + - itis, inflammation A ganglion cyst is a fluid-filled bump associated with a joint or tendon sheath. They most often occur at the back of the wrist, followed by the front of the wrist. Onset is often over months. Typically there are no further symptoms. Occasionally pain or numbness may occur. Complications may include carpal tunnel syndrome.. The cause is unknown. The underlying mechanism is believed to involve. Diagnosis of Achilles tendon enthesitis according to swelling and tenderness at the insertional site of the Achilles tendon into the calcaneus. Onset of heel pain ≥ 1 month at Baseline. Heel enthesitis that is magnetic resonance imaging (MRI)-positive according to the investigator's judgement
Enthesitis, inflammation at the attachment sites of tendons, ligaments, fascia, and joint capsules to bones plays a critical role in the pathogenesis of spondyloarthritis (SpA), including psoriatic arthritis (PsA). Magnetic resonance imaging (MRI) has aided in a better understanding of pathophysiology, early diagnosis, prognostication, therapeutic outcomes, and follow up of enthesitis Sjogren's Musculoskeletal Pain Not Related to Enthesitis. An assessment of entheses involvement using ultrasonography has found that musculoskeletal pain in patients with Sjogren's Syndrome is not due to enthesitis. This prospective study included 25 Sjogren's female patients (mean age, 53.2 + 11.3 yrs) and 25 sex and age-matched controls. This is called enthesitis. Common sites for this inflammation are at the heel, the top and bottom of the kneecap (patella), the ball of the foot and bottom of the foot at the heel (plantar fascia). Also, in some patients with ERA, inflammation in the joints of the foot, mainly in the mid-foot zone (tarsitis), is seen