Ch. 21 - Arthropathies of IBD Flashcards
2 patterns of joint inflammation of IBD
1) Peripheral polyarthritis
2) Involvement of SI joints and axial skeleton
T/F: In IBD, arthralgia is more common than arthritis
T
Ratio of boys to girls in those with and without peripheral arthritis in IBD
Almost identical
T/F There is a pronounced tendency for familial clustering in UC and CD
T
T/F SI arthritis is more common in patients with IBD compared to the general population
T, >30x
Peripheral polyarthritis vs SI arthritis: Associated with HLA-B27
SI arthritis
Most frequently affected joint in IBD arthritis
Lower extremity joints, esp ankles and knees
Usual duration of peripheral arthritis in IBD
1-2 weeks, and tend to recur
Arthritis of IBD may last for months especially if
GI disease is active
T/F If joint inflammation in IBD lasts for months, permanent functional loss or joint damage ensues
F, permanent functional loss or joint damage is unusual
SI arthritis vs peripheral arthritis: May reflect activity and course of GI inflammation
Peripheral arthritis
SI arthritis vs peripheral arthritis: More common in IBD arthritis
Peripheral arthritis
T/F IBD arthritis may be accompanied by enthesitis
T, SI arthritis in particular
Very painful MSK complication of IBD that occurs symmetrically in the limbs, rather than the joints, and may be accompanied by increased sweating and purplish discoloration of the affected limbs
Hypertrophic osteoarthropathy
T/F Osteoporosis can take place in patients with IBD arthritis even without steroid use
T
Severe form of IBD that appears to be an autoinflammatory, and is associated with treatment-resistant colitis, perianal fistula formation, folliculitis, and arthritis
Infantile-onset IBD
Infantile onset IBD results from
Mutations in IL-10 or its receptor
Treatment for infantile-onset IBD that may be curative
Hematopoietic stem cell transplantation early in the course of disease
UC vs CD: Bloody diarrhea
UC
Perianal skin tags and fistulae
CD
T/F In IBD arthritis, GI symptoms usually precede joint disease by months or years
T
T/F: In IBD arthritis, joint symptoms may precede GI symptoms or intestinal disease
T
When arthritis precedes GI symptoms in IBD, arthritis resembles what chronic arthritides
JIA, JAS, or seronegative enthesopathy and arthropathy syndrome
T/F: Mucocutaneous manifestations of IBD are less common in patients who have arthritis compared to those without arthritis
F, more common especially in those with peripheral arthritis
T/F: There is a higher frequency of arthritis in children with extensive, compared to segmental, bowel disease
T
T/F: Patients with IBD arthritis usually have active gut disease
T
Erythema nodosum (nodular panniculitis) in IBD occur most commonly in what area
Subcutaneous fat of the pretibial region
Lesions of IBD that are erythematous, painful, slightly elevated, 1-2 cm in diameter, appear in groups and reappear sequentially in new areas after several days
Erythema nodosum
T/F: IBD erythema nodosum is more likely associated with SI joint involvement
F, Peripheral arthritis of short duration and involving a few joints
IBD skin lesion that begins as a pustule that breaks down and rapidly enlarges to forma chronic, painful, deep undermined ulcer with a red, raised border
Pyoderma gangrenosum
Lesions of IBD that if recurrent and precedes intestinal symptoms, may lead to a misdiagnosis of Behcet’s
Painful oral ulcerations seen particularly in CD
T/F: IBD vasculitis can affect both small and large vessels
T
Uveitis in IBD vs Spondyloarthritis: More frequent HLA-B27 positivity
Spondyloarthritis
Uveitis in IBD vs Spondyloarthritis: More common episcleritis, scleritis, and glaucoma
IBD
Usual characteristics of uveitis in IBD: Location, onset, duration, symptom
Bilateral, posterior, insidious onset, chronic duration, asymptomatic
RF in IBD arthritis
Negative
ANA in IBD arthritis
Negative
Antibodies that are frequently present in the sera of children with IBD
pANCA and ASCA
UC vs CD: ANCA is more common
UC
T/F: Vasculitis is more common in IBD patients with positive ANCA
F
WBC range in synovial fluid of adults
5000-15000/mm3 or 5-15x10^9/L
Predominant cell type in the synovial fluid of patients with IBD arthritis
Neutrophils
T/F: Protein, glucose, and complement levels in synovial fluid of patients with IBD arthritis are low
F, normal
T/F: SI arthritis of IBD is distinguishable from that associated with juvenile AS on radiograph
F
Successful management of peripheral arthritis in IBD generally depends on effective treatment of GI disease
T
Successful management of HLA-B27-associated spondylitis in IBD generally depends on effective treatment of GI disease
F, this is more likely independent of the GI activity
T/F: Colectomy in UC may be followed by a striking remission in peripheral joint symptoms
T
Treatment for IBD peripheral arthritis that can exacerbate disease
NSAIDs
NSAID alternative when NSAID exacerbates IBD
Selective COX-2 inhibitor
Best management for arthropathy of IBD
Early sulfasalazine or glucocorticoids
Why are sulfasalazine or glucocorticoids considered best management for IBD arthropathy
Beneficial effect on GI inflammation
Treatment for persistent IBD arthritis in 1 or 2 joints
Intraarticular glucocorticoids
Use of this predominantly topical steroid in CD may result in remission of joint symptoms
Oral budesonide
Treatment for IBD arthropathy that can result in improvement of both GI symptoms and arthritis
Sulfasalazine, glucocorticoids, MTX, anti-TNF particularly infliximab
Treatment for IBD arthropathy that may be used for patients who fail infliximab therapy
Adalimumab
Patients with these chronic arthritides may have an increased risk for developing IBD
ERA, PsA, extended oligoarticular arthritis
Initial drug of choice for HLA-B27 associated spondylitis of IBD
Sulfasalazine at 30-50mkday, max 2.5g/day
Treatment options for patients with HLA-B27 associated spondylitis of IBD who fail initial treatment with sulfasalazine
MTX and anti-TNF agents
Treatment for vasculitis associated with IBD
Systemic glucocorticoids
Treatment options for IBD uveitis
Topical glucocorticoids, more immunosuppression with MTX and anti-TNF may be necessary
Most important determinant of overall prognosis in the child with IBD and arthritis
Outcome of GI disease
T/F: Permanent changes in the spine and hips of children with IBD arthritis with axial disease are frequent
T
