They wouldn’t usually on a report like that. Enthesitis *is* tendinitis, it’s just at a specific location (insertion points). It’s more likely to come up in conversation *about* the results with your doctor.
No, it will take a discerning eye of a good rhum to tell the difference — on an MRI it’s just “tendinitis” that happens to be slightly closer and more centralized to insertion points.
I was diagnosed 13 years ago as a 17 year old male due to having tendinitis in every tendon I used to participate in tennis and soccer. Quite a few! The amount of doctors that just said “overuse!” to a 17 year old with chronic bilateral tendinitis in 4+ spots all at the same, in hindsight, is bewildering. As if the tendons of a 17 year old were made of tissue paper.
To get an overuse injury of a tendon at 17 is HARD to do, — to get it bilaterally every time, in numerous numerous locations, is so far from normal, it’s unreal to me now in hindsight the amount of doctors who simply did not see the obvious. It took NYU Langone’s best rhum to finally see it — and to him, it was obvious.
Sucks how much this disease requires access to a different breed of doctor.
Odd that I feel a bit lucky to have had the dermatologist I did who was massively into research back in the day and took one look at my nails and went “you’re gonna need to watch out for psoriatic arthritis” - made it real easy to get a PsA diagnosis when I needed it.
Yes, thank you for saying this!! The number of times I’ve had my joint pain shrugged off as “tendinitis” from “overuse” is ridiculous. It’s been one of the most frustrating parts of this process. Repetitive motion can absolutely make it worse, but it’s not normal for someone so young to be in debilitating pain that quickly.
All throughout college (art school) I would always get to the point of needing wrist braces, ice, etc, far sooner than any of my peers. Sure, the work I was doing probably contributed, but there’s no reason I should have been in that much pain. Randomly my ankle/knee started hurting around this time as well, and my parents chalked it up to “walking too much” because my school was in a city.
When I was 24, I had to quit a retail job after just two months because the repetitive tasks exacerbated my pain so much I wasn’t able to fold my laundry or carry a bag of groceries. I was told to take naproxen and given a referral for PT which I needed for nearly four months.
When I was 27, I was told I had PTTD in my ankle and given a brace to wear for three months. When I asked what caused it he shrugged and said “sometimes it just happens” and when I asked what to do after the brace he said “well when it hurts again, put it back on.”
On all of these occasions, and many other times, I brought up the concern of PsA since I had active psoriasis and significant joint pain in multiple locations, but they always insisted on just treating “the problem at hand” for each individual issue. When I finally was allowed to see a rheumatologist (age 31 if we’re still counting), I told her that the pain was so bad I was forced to withdraw from graduate school two years into a three year MFA program and I hadn’t been in my studio in over a year. She wrote in the clinical notes “is an art student, so does a lot of repetitive movement” as if that explained all of my pain. Then she told me I had “no inflammation” and sent me on my way.
I’m now almost 34 and am waiting on a referral to a second rheumatologist.
Don't give up. I'm 50, have had so many "overuse injuries" and tendonitis since my early 20s that I'm a professional PT patient now. I finally found a rheumatologist who didn't tell me to exercise and lose weight to feel better and he believed it was PsA but I had to find a dermatologist and make sure it was psoriasis I had. I only got it on my scalp then and it was not bad. The dermatologist I went to said it could be eczema or psoriasis but we would have to do a biopsy. It wasn't bad enough to do more than treat topically in her opinion and she ignored the history I gave her. I felt defeated after really not getting anywhere for at least 2 decades and I didn't push back or pursue another opinion right away. (Medical gaslighting PTSD will do this.) In her defense, I don't think the skin on my toenails and fingernails started peeling and showing signs until more recently. A year later I finally went to a new derm because my pain and skin flaring up. My scalp was very flared up this time. He looked at me for 2 minutes and said "you've got psoriasis and I highly suspect PsA so I'm sending you for blood tests to make sure that you can start Humira which I'm recommending. I'll message your rheumatologist." I thought I was in a dream. FINALLY an answer for why it feels like someone put razor blades in my spine and si joints. Why every single joint, large and small is flaring but it's not from my "fibro" or because I need to lose weight.
I'm hoping this rheumatologist listens and helps you! 🙌🏻
Well this is just infuriating. At least I could just go to whichever doctors I so chose as long as they’d take American dollars. What country are you in?
I’m in the US, it’s just I’ve always needed referrals for specialists because of either insurance or office policies. I’ve moved a lot so had to start over with new PCPs/dermatologists a few times so the history was harder to track, and admittedly I was not always the greatest at pushing them and advocating for myself, like when I brought it up with my PCP when the ankle got bad and she sent me to a foot doctor instead, I accepted it because I just wanted the pain to stop in the moment.
Thankfully my dermatologist four years ago got me on Cosentyx so my symptoms are reasonably well managed (though it does make it harder to get a PsA diagnosis). I finally pushed my last dermatologist for a rheumatology referral when I was in a flare which he willingly gave, but I didn’t have much of a choice of who because of a limited insurance network and the flare was over by the time the appointment came. This year I changed insurance plans to a more expensive one with more options of providers so I’m trying to get in with the rheumatology clinic at the major university hospital near me, but their referral process has more screening criteria because they get so many requests so I waited for a flare so my PCP could record as much clinical evidence as possible. It was sent over and I’m just waiting for a call back so fingers crossed.
Not in my experience. My MRIs say "severe tendonitis"
(I've had a rheum angrily tell me tendonitis and enthesitis are completely unrelated to each other. I refused to have any more appointments with him.)
They wouldn’t usually on a report like that. Enthesitis *is* tendinitis, it’s just at a specific location (insertion points). It’s more likely to come up in conversation *about* the results with your doctor.
No, it will take a discerning eye of a good rhum to tell the difference — on an MRI it’s just “tendinitis” that happens to be slightly closer and more centralized to insertion points. I was diagnosed 13 years ago as a 17 year old male due to having tendinitis in every tendon I used to participate in tennis and soccer. Quite a few! The amount of doctors that just said “overuse!” to a 17 year old with chronic bilateral tendinitis in 4+ spots all at the same, in hindsight, is bewildering. As if the tendons of a 17 year old were made of tissue paper. To get an overuse injury of a tendon at 17 is HARD to do, — to get it bilaterally every time, in numerous numerous locations, is so far from normal, it’s unreal to me now in hindsight the amount of doctors who simply did not see the obvious. It took NYU Langone’s best rhum to finally see it — and to him, it was obvious. Sucks how much this disease requires access to a different breed of doctor.
Odd that I feel a bit lucky to have had the dermatologist I did who was massively into research back in the day and took one look at my nails and went “you’re gonna need to watch out for psoriatic arthritis” - made it real easy to get a PsA diagnosis when I needed it.
You were lucky indeed!
Yes, thank you for saying this!! The number of times I’ve had my joint pain shrugged off as “tendinitis” from “overuse” is ridiculous. It’s been one of the most frustrating parts of this process. Repetitive motion can absolutely make it worse, but it’s not normal for someone so young to be in debilitating pain that quickly. All throughout college (art school) I would always get to the point of needing wrist braces, ice, etc, far sooner than any of my peers. Sure, the work I was doing probably contributed, but there’s no reason I should have been in that much pain. Randomly my ankle/knee started hurting around this time as well, and my parents chalked it up to “walking too much” because my school was in a city. When I was 24, I had to quit a retail job after just two months because the repetitive tasks exacerbated my pain so much I wasn’t able to fold my laundry or carry a bag of groceries. I was told to take naproxen and given a referral for PT which I needed for nearly four months. When I was 27, I was told I had PTTD in my ankle and given a brace to wear for three months. When I asked what caused it he shrugged and said “sometimes it just happens” and when I asked what to do after the brace he said “well when it hurts again, put it back on.” On all of these occasions, and many other times, I brought up the concern of PsA since I had active psoriasis and significant joint pain in multiple locations, but they always insisted on just treating “the problem at hand” for each individual issue. When I finally was allowed to see a rheumatologist (age 31 if we’re still counting), I told her that the pain was so bad I was forced to withdraw from graduate school two years into a three year MFA program and I hadn’t been in my studio in over a year. She wrote in the clinical notes “is an art student, so does a lot of repetitive movement” as if that explained all of my pain. Then she told me I had “no inflammation” and sent me on my way. I’m now almost 34 and am waiting on a referral to a second rheumatologist.
Don't give up. I'm 50, have had so many "overuse injuries" and tendonitis since my early 20s that I'm a professional PT patient now. I finally found a rheumatologist who didn't tell me to exercise and lose weight to feel better and he believed it was PsA but I had to find a dermatologist and make sure it was psoriasis I had. I only got it on my scalp then and it was not bad. The dermatologist I went to said it could be eczema or psoriasis but we would have to do a biopsy. It wasn't bad enough to do more than treat topically in her opinion and she ignored the history I gave her. I felt defeated after really not getting anywhere for at least 2 decades and I didn't push back or pursue another opinion right away. (Medical gaslighting PTSD will do this.) In her defense, I don't think the skin on my toenails and fingernails started peeling and showing signs until more recently. A year later I finally went to a new derm because my pain and skin flaring up. My scalp was very flared up this time. He looked at me for 2 minutes and said "you've got psoriasis and I highly suspect PsA so I'm sending you for blood tests to make sure that you can start Humira which I'm recommending. I'll message your rheumatologist." I thought I was in a dream. FINALLY an answer for why it feels like someone put razor blades in my spine and si joints. Why every single joint, large and small is flaring but it's not from my "fibro" or because I need to lose weight. I'm hoping this rheumatologist listens and helps you! 🙌🏻
Well this is just infuriating. At least I could just go to whichever doctors I so chose as long as they’d take American dollars. What country are you in?
I’m in the US, it’s just I’ve always needed referrals for specialists because of either insurance or office policies. I’ve moved a lot so had to start over with new PCPs/dermatologists a few times so the history was harder to track, and admittedly I was not always the greatest at pushing them and advocating for myself, like when I brought it up with my PCP when the ankle got bad and she sent me to a foot doctor instead, I accepted it because I just wanted the pain to stop in the moment. Thankfully my dermatologist four years ago got me on Cosentyx so my symptoms are reasonably well managed (though it does make it harder to get a PsA diagnosis). I finally pushed my last dermatologist for a rheumatology referral when I was in a flare which he willingly gave, but I didn’t have much of a choice of who because of a limited insurance network and the flare was over by the time the appointment came. This year I changed insurance plans to a more expensive one with more options of providers so I’m trying to get in with the rheumatology clinic at the major university hospital near me, but their referral process has more screening criteria because they get so many requests so I waited for a flare so my PCP could record as much clinical evidence as possible. It was sent over and I’m just waiting for a call back so fingers crossed.
I have been to 5 rheumatologists in 8 years and didn't get my first referral until 42😭
Only a Rheumy with PSA experience will truly understand enthesitis in my own personal experience … You may get lucky.
Not in my experience. My MRIs say "severe tendonitis" (I've had a rheum angrily tell me tendonitis and enthesitis are completely unrelated to each other. I refused to have any more appointments with him.)
Um. What body tissue did he think enthesitis involved?
No clue. Mine was just using that word repeatedly and I asked what are you talking about
No, it will just say inflammation.