Dealing with Disorder, Part One: Living With Enthisitis

Dealing with Disorder, Part One: Living With Enthisitis

Skip Pulley

Author's Note:
I have been, in varying degrees of constant and consistent physical pain for most of my adult life. Some days, weeks, months and years, are better than others.

I have multiple auto-immune disorders that run "concurrently" as it were. 

My specific physical conditions (enthesitis, arthritis, tendon disorder, sepsis in joints and narcolepsy) have combined to create a "perfect storm" of cause and effect, leading to multiple lifelong misdiagnoses. For example, when I was a teenage athlete, I was misdiagnosed with chronic fatigue syndrome. However, I was actually suffering from a type of narcolepsy related to autoimmune issues that were undiagnosed. Narcolepsy is an autoimmune disorder where immune cells mistakenly destroy hypocretin-producing neurons, creating a link with autoimmune arthritis through shared genetics and immune dysfunction. I understood that I had formerly been a childhood insomniac, but I believed that the condition had been outgrown, not understanding that it had simply "evolved" (technically, I only "sleep" about 1.5 to 2 hours per night; the balance of my designated sleep-time is spent lying still with my eyes closed - 

which is a long story and an entirely different subject and article for another time). 

While in my 30s, I became aware of my accelerated healing ability, which is due to rapid tissue regeneration, 

which was necessitated by a continual systemic breakdown and rebuild, and round and round it goes, 

i.e. "the perfect storm" (which sounds better aloud than "cycle of chronic illness")

I selected enthisitis to begin this series of sharing and insight, because it is by far the most torturous. 

Someone once asked my to describe it, and my response was... 

that when I woke up in the morning, it felt like my hands and feet were being crushed in a vice. 

After hearing gasps and stunned silence, I read the room and stopped describing it - Skip Pulley

As with all my self-care articles, be sure to consult with a healthcare or wellness professional 

before starting any new regimen. 

They can help you tailor a plan that suits your needs and monitors your progress.

Enthesitis is the inflammation of entheses, which are the points where tendons, ligaments, or joint capsules attach to bone. This condition can cause pain, stiffness, and swelling in the affected areas. 

It is often associated with spondyloarthritis (SpA), a group of inflammatory rheumatic diseases that include ankylosing spondylitis (AS), psoriatic arthritis (PsA), and reactive arthritis.

Autoimmune enthesitis is the painful inflammation of the entheses sites where tendons or ligaments attach to bone caused by an overactive immune system.

Symptoms:

1. Pain and tenderness at the site of tendon or ligament attachment to bone.

2. Swelling or inflammation in the affected area.

3. Stiffness, especially in the morning or after periods of inactivity.

4. Limited mobility or range of motion in the affected joint.

Similarities with Rheumatoid Arthritis (RA):

1. Inflammatory nature: Both enthesitis and RA are inflammatory conditions that can cause pain, swelling, and stiffness in the joints.

2. Impact on joints and mobility: Both conditions can affect joint function and mobility, leading to decreased quality of life if left unmanaged.

3. Association with other conditions: Enthesitis is often associated with spondyloarthritis, while RA is an autoimmune disease that can have extra-articular manifestations.

Differences from RA:

1. Location of inflammation: Enthesitis specifically involves inflammation at the enthesis (tendon/ligament attachment to bone), whereas RA typically involves inflammation of the synovium (joint lining).

2. Disease mechanisms: The underlying disease mechanisms differ between enthesitis (often associated with spondyloarthritis) and RA (an autoimmune disease).

Lifestyle Guidelines:

1. Exercise: Engage in gentle exercises like yoga, swimming, or stretching to maintain joint mobility and reduce stiffness. Avoid high-impact activities that can exacerbate enthesitis.

2. Rest: Balance exercise with rest to manage inflammation and pain.

3. Stress management: Engage in stress-reducing activities like meditation or deep breathing exercises to help manage symptoms.

4. Sleep: Get enough sleep (7-9 hours) to help manage inflammation and fatigue.

Dietary Guidelines:

1. Anti-inflammatory foods: Include foods with anti-inflammatory properties like omega-3 fatty acids (salmon, flaxseeds, chia seeds), antioxidants (berries, leafy greens), and turmeric/curcumin in your diet.

2. Avoid inflammatory foods: Limit or avoid foods that can trigger inflammation, such as processed meats, dairy (if you're sensitive), and gluten (if you have gluten sensitivity).

3. Hydration: Stay hydrated to help maintain joint health.

Management with Natural Supplements 

1. Turmeric/Curcumin: Curcumin has potent anti-inflammatory and antioxidant properties. Take 500-1000 mg of curcumin supplements twice a day for anti-inflammatory effects.

2. Ginger: Ginger has anti-inflammatory compounds that may help reduce pain and inflammation. Consume ginger tea or take ginger capsules (250-500 mg twice a day) for anti-inflammatory effects.

3. Boswellia: Boswellia serrata has anti-inflammatory and pain-relieving properties. It is native to the mountainous regions of Northern Africa, India, and the Middle East. Boswellia is an herbal extract also known as "Indian frankincense". Take 300-400 mg of boswellia supplements twice a day for anti-inflammatory effects.

4. MSM: MSM may help reduce inflammation and promote joint health. (MSM) is a sulfur-containing compound often used to manage joint pain, stiffness, and inflammation associated with arthritis. Research shows potential for reducing musculoskeletal discomfort.

A Closer Examination of Enthesitis

Potential Causes and Symptoms

The exact causes of enthesitis are not fully understood, but it is believed to be related to a combination of genetic, environmental, and immune system factors. Some potential triggers include:

• Trauma or injury to the affected area

• Overuse or repetitive strain

• Infections

• Autoimmune disorders

• Genetic predisposition

Symptoms of enthesitis may include:

• Pain and stiffness in the affected area, particularly in the morning or after periods of rest

• Swelling and redness around the affected enthesis

• Limited mobility and reduced range of motion

• Tenderness to the touch

• Warmth or heat in the affected area

Detailed Lifestyle Guidelines

To manage enthesitis, consider the following lifestyle guidelines:

1. Exercise regularly: Gentle exercises like yoga, swimming, or cycling can help maintain joint mobility and reduce stiffness. Avoid high-impact activities that may exacerbate the condition.

2. Maintain a healthy weight: Excess weight can put additional stress on the affected joints and entheses.

3. Improve posture: Good posture can help reduce strain on the affected areas.

4. Manage stress: Stress can exacerbate enthesitis symptoms. Engage in stress-reducing activities like meditation, deep breathing, or yoga.

5. Get enough sleep: Adequate sleep is essential for joint health and immune function.

Detailed Dietary Guidelines

Some dietary changes may help alleviate enthesitis symptoms:

1. Omega-3 rich foods: Include omega-3 fatty acid-rich foods like fatty fish, flaxseeds, and chia seeds in your diet to reduce inflammation.

2. Antioxidant-rich foods: Consume antioxidant-rich foods like fruits, vegetables, and nuts to reduce oxidative stress.

3. Avoid inflammatory foods: Limit or avoid foods that can trigger inflammation, such as:

   • Processed meats

   • Refined sugars

   • Dairy products (if you're lactose intolerant or sensitive)

   • Gluten (if you have a gluten intolerance or sensitivity)

4. Stay hydrated: Drink plenty of water to help maintain joint health and reduce inflammation.

Additional Similarities with Rheumatoid Arthritis (RA)

Enthesitis shares some similarities with RA, including:

1. Autoimmune component: Both enthesitis and RA are characterized by an abnormal immune response, which can lead to chronic inflammation and joint damage.

2. Inflammatory nature: Both conditions involve inflammation, which can cause pain, stiffness, and swelling in the affected areas.

3. Joint involvement: Both enthesitis and RA can affect multiple joints, leading to reduced mobility and increased risk of joint damage.

4. Systemic impact: Both conditions can have systemic implications, such as fatigue, fever, and overall decreased quality of life.

However, there are also some key differences between enthesitis and RA:

1. Location of inflammation: Enthesitis is characterized by inflammation at the entheses, whereas RA typically involves inflammation of the synovial lining of joints.

2. Disease progression: Enthesitis can lead to chronic inflammation and damage to the affected entheses, whereas RA can cause joint destruction and deformity if left untreated.

3. Treatment approaches: While both conditions may require anti-inflammatory and immunosuppressive therapies, the specific treatment approaches may differ depending on the underlying condition and severity of symptoms. 

Consult with a healthcare professional before starting any new therapies or supplements, especially if you're already taking medications or have underlying health conditions.

Skip Pulley

Kahuna Life™

*The "Cycle of Chronic Illness" refers to the cyclical nature of my collective disorders.  Narcolepsy causes fragmented sleep, which weakens the immune system and increases autoimmune flares, leading to higher inflammation, chronic pain, and worsened symptoms for both conditions. Narcolepsy patients also have higher rates of other autoimmune-related conditions like Sjögren’s syndrome, Vitiligo, and Graves' disease. Systemic Inflammatory Response is a widespread condition, often characterized by severe fatigue, fever, and flu-like symptoms, indicating total body involvement. A holistic approach to existence is the only successful remedy. Once, when I was 17, the tendons around my ribcage were strained after a blindside tackle playing rugby, causing spinal tendonitis, for which the only effective pain reliever was cannabis sativa. While at a follow up doctor's appointment, after she said she was amazed that I was up and around so quickly, I asked her if I was some kind of "mutant". 

She smirked and chuckled a bit, but she did not answer me.