Enteropathic arthritis

Question 1

Key Points:
•Arthritis associated with ??? (3 CONDITIONS)
•Usually ??? arthritis and self-limiting
•Affects multiple ??? 2 ??? joints
•This is generally a diagnosis of ???
•Treatment needs to focus on the ??? inflammation!

Answer 1

Key Points:
•Arthritis associated with inflammatory bowel disease (Crohn’s/Colitis) and other GI conditions.
•Usually non-destructive arthritis and self-limiting
•Affects multiple joints (axial and peripheral joints)
•This is generally a diagnosis of exclusion
•Treatment needs to focus on the intestinal inflammation!

Question 2

Clinical Features:
Polyarthritis affecting multiple joints: 3??
    •Type 1 arthropathy: ???
    •Type 2 arthropathy: ???
•Spondylitis can occur.
•Arthritis is generally ??? and ???; 
*??? changes may occur.
•Patient has a history (or family history) of ??? or ???

Answer 2

Clinical Features:
Polyarthritis affecting multiple joints: spine, SI, peripheral joints
•Type 1 arthropathy: acute, affecting < 5 joints; associated with bowel flares, self limiting; no joint damage, large lower limb joints
•Type 2 arthropathy: more chronic, MCP joints mostly, can be migratory, symmetrical, does not associate with bowel flares; > 5 joints
•Spondylitis can occur.
•Arthritis is generally nondestructive and reversible; *erosive changes may occur.
•Patient has a history (or family history) of Crohn’s or Ulcerative Colitis.

Question 3

Diagnostic Testing:
•HLA-B27 – found in ???% of pts with ???
•Joint aspiration – increased ???
•Radiographic imaging – 5
•Diagnosis is one of ???

Answer 3

Diagnostic Testing:
•HLA-B27 – found in 50-75% of patients with spinal arthritis
•Joint aspiration – increased leukocytes
•Radiographic imaging – soft-tissue swelling, osteoporosis, effusions; erosions or destruction is generally not seen.
•Diagnosis is one of exclusion

Question 4

Conventional Medications:
•NSAIDs – for ???

• DMARDs (2)
• TNF Inhibitors (2)

Answer 4

Conventional Medications:
•NSAIDs – for pain relief
•Use caution because of GI side effects.

• DMARDs
  
  • Sulfasalazine
  • Methotrexate
• TNF Inhibitors
  
  • Infliximab
  • Adalimumab

Question 5

Dietary Modifications:

Eliminate food allergens: 2

??? Diet
Avoid ??? 2

Reduction in inflammatory foods: 3

Answer 5

Eliminate food allergens:

- Gluten
- Dairy

• Elemental Diet
• Avoid alcohol/smoking

Reduction in inflammatory foods:

- Sugar
- Red meats
- Dairy

Question 6

Dysbiosis:

•Herbal anti-microbial agents: 4

Answer 6

Dysbiosis:
Herbal anti-microbial agents:
•Berberine – 500mg BID
•Oregano Oil – 300mg BID
•St. John’s Wort – 400 – 600mg BID - TID
•Include probiotics

Question 7

Immune Modulation: 8

Answer 7

Immune Modulation:
•Vitamin D – 2,000 – 4,000IU21
•Vitamin C – 1,000 – 2,000mg per day
•EFA’s – 3,000 – 6,000mg per day.
•Selenium – 400 – 600mcg/day
•Zinc – 60mg per day
•Vitamin E – 400IU/day
•L-Carnitine – 2g/day
•Folic Acid – 50 – 150mg/day

Question 8

Botanical Medicine: 4

Answer 8

Botanical Medicine:

• Cucumin: 1 – 1.5g/day in divided doses23
• Boswellia: 350mg TID
• Aloe Vera 50% gel: 100mL of oral preparations
• Robert’s Formula

Question 9

Toxicity:

•Always do what?

Answer 9

Toxicity:

•Always check for heavy metal toxicity or xenobiotic exposure if above treatment doesn’t work as well.