Is there always swelling with enthesitis?

Yes, swollen : Enthesitis or enthesiopathy is inflammation where tendons or ligaments insert into the bone. Recurring stress or inflammatory autoimmune disease can cause inflammation or occasionally fibrosis and calcification. One common site is at the heel, particularly the achilles tendon.It is associated with hla b27 arthropathies like ankylosing spondylitis, psoriatic arthritis, and reactive arthritis.