Enteropathic Arthritis

Refers to an inflammatory arthritis involving the peripheral joints and sometimes the spine, occuring in patients with inflammatory bowel disease

Aetiology

  • 10-20% of IBD sufferers will experience spine or joint problems
  • 20% of patients with Crohn's will have sacroiliitis
  • Worsening of symptoms during flare-ups of IBD

Pathophysiology

  • Organisms with high lipopolysacharides in cell wall trigger immune reaction

Clinical presentation

Symptoms

  • Patients present with arthritis in several joints, especially knees, ankles, elbows, and wrists, sometimes spine, hips, or shoulders
  • GI - loose, watery stool with mucous and blood
  • Weight loss

Signs

  • Low grade fever
  • Uveitis
  • Pyoderma gangrenosum
  • Enthesitis - archilles tendontitis, plantar fasciitis, lateral epicondylitis
  • Aphthous ulcers

Investigations

  • Upper and lower GI endoscopy with biopsy showing ulceration/colitis
  • Joint aspirate - no organisms or crystals (rules out septic arthritis and crystal arthropathies)
  • ↑ inflammatory markers
  • X-ray/MRI - sacroiliitis
  • USS - synovitis/tendosynovitis

Management

  • Usually involves finding mediation to manage both the underlying condition and the arthritis
  • Management of the arthritis similar to other seropositive arthritis (physio, NSAIDs, DMARDs, anti-TNF etc.)