[6] Enteropathic Arthritis Flashcards
What is enteropathic arthritis?
A form of chronic, inflammatory arthritis associated with the occurence of inflammatory bowel disease, for example UC and Crohn’s disease
What proportion of people with UC or Crohn’s will develop enteropathic arthritis?
About 1/5
Other than inflammator bowel disease, what conditions can enteropathic arthritis be associated with?
- Whipple’s disease
- Coeliac disease
- GI bypass
What joints are most commonly affected with enteropathic arthritis?
- Peripheral limb joints
- Sometimes entire spine
What is the pathophysiological process in enteropathic arthritis?
It is not fully understood, but it is thought that the long-lasting inflammation found in the intestines of people with IBD damages the bowl, which may allow the bacteria to enter the damaged bowel wall, and circulate through the blood stream. The body then mounts an immune response to the bacteria, which causes other problems, including inflammation of the joints and/or spine
What gene is involved with enteropathic arthritis?
HLA-B27 - those who test positive are much more likely to have spinal involvement with enteropathic arthritis
What are the symptoms of enteropathic arthritis?
They are the symptoms of inflammatory bowel disease alongside the arthritis symptoms in the joints.
What comes first, the IBD symptoms or the arthritis symptoms?
Usually IBD, but not always
How is enteropathic arthritis diagnosed?
- History and examination to determine the presence of arthritis
- Tests to determine if underlying bowel disease is present, if not already established
What tests can be done to determine a diagnosis of IBD in enteropathic arthritis?
- Stool culture
- Colonoscopy
- Blood tests looking for ESR or CRP
What investigations might be done into the arthritis component of enteropathic arthritis?
Synovial fluid samples and x-rays of affected joint
How is enteropathic arthritis treated?
Enteropathic arthritis often improves with the treatment of bowel symptoms, so the underling condition should be treated as normal. However, avoid NSAIDS
DMARDs can be used in resistant cases
Otherwise, treatment should be the same as for other forms of arthritis, including a regimen of analgesia, exercise, and physical therapy. In severe cases, posture correcting surgery can be an option.
What are the risk factors for enteropathic arthritis?
- HLA-B27 positivity
- Active bowel disease
- Family history of IBD
- Appendectomy
- Cigarette smoking
- Presence of other extra-intestinal manifestations, such as erythema nodosum or polyderma gangrenosum
