enteropathic arthritis; inflammatory bowel-associated arthritis
Jump to navigation
Jump to search
Etiology
Epidemiology
- large joint oligoarthritis
- equal incidence in men & women
- spondylitis
- more common in men than women
Genetics
- large joint oligoarthritis
- NO association with HLA-B27
- spondylitis
- ankylosing spondylitis, isolated sacroiliitis
- association with HLA-B27
Clinical manifestations
- peripheral vs central
- varies with inflammatory bowel disease (IBD) activity
- often coincide with flares of IBD, but not always
- may follow flare of inflammatory bowel disease
- two patterns of peripheral arthritis:
- asymmetric, predominantly large joint oligoarthritis
- involves lower extremities, knee, foot[1]
- may occur in association with Crohn's disease or ulcerative colitis
- asymmetric, predominantly large joint oligoarthritis
- peripheral joint flares parallel the course of the inflammatory bowel disease[1]
- polyarticular small joint arthritis
- involves upper extremities
- does not parallel inflammatory bowel disease activity
- dactylitis
- polyarticular small joint arthritis
- enthesitis
- spondylitis
- may be asymptomatic or follow a course similar to ankylosing spondylitis[1]
- sacroiliitis often asymmetric
- does not parallel inflammatory bowel disease activity
- occurs with higher frequency in ulcerative colitis
- generally non-erosive[1]
- dermatologic manifestations
- ophthalmic manifestations
- anterior uveitis
- conjunctivitis, keratitis & episcleritis are rare
- nephrolithiasis
- thromboembolism
Laboratory
- serum 25-hydroxyvitamin D
- high risk of vitamin D deficiency
- sometimes HLA-B27 positive[1]
Radiology
- low bone density (risk of fracture)
- lumbar spine radiographs for spondylitis (low back pain)
- MRI of sacroiliac joints if lumbar spine radiographs negative & sacroiliitis suspected
Complications
- high risk for vitamin D deficiency, low bone mineral density & fracture[1]
Management
- short term use of NSAIDs
- mainstay of treatment
- may exacerbate inflammatory bowel disease in some patients
- do NOT initiate NSAID therapy during periods of active bowel disease
- arthritis is seldom a problem during periods of systemic glucocorticoid therapy for flares of bowel disease
- sulfasalazine is a 2nd line agent
- indicated for recurrent joint inflammation[1][3]
- effective for both intestinal & joint inflammation
- methotrexate & azathioprine may be of benefit for both intestinal & joint inflammation
- intra-articular glucocorticoids
- TNF-alpha inhibitor for severe cases[1]
- ustekinumab (IL12 & IL23 inhibitor) for severe cases[1]
- antibiotics of no benefit in enteropathic arthritis
- rule out infection when treating a monoarticular arthritis
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Weiner, S. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 3.0 3.1 De Vos M Joint involvement in inflammatory bowel disease: managing inflammation outside the digestive system. Expert Rev Gastroenterol Hepatol. 2010 Feb;4(1):81-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20136591
- ↑ Wordsworth P. Arthritis and inflammatory bowel disease. Curr Rheumatol Rep 2000 Dec 21; 2:87-88 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11123044
- ↑ Arvikar SL, Fisher MC. Inflammatory bowel disease associated arthropathy. Curr Rev Musculoskelet Med. 2011 Sep;4(3):123-31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21710141
- ↑ Peluso R, Manguso F, Vitiello M, Iervolino S, Di Minno MN. Management of arthropathy in inflammatory bowel diseases. Ther Adv Chronic Dis. 2015 Mar;6(2):65-77. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25729557 Free PMC Article