Enthropathic arthritis

Question 1

What is the pathogenesis & association of enteropathic arthritis?

Answer 1

Occurs in 10-15% of patients who have UC and CD

• Remission of UC or total colectomy  usually leads to remission of arthritis
• However, arthritis can persist even in well-controlled CD

Selective mucosal leakiness may expose individual to antigens that trigger synovitis

Question 2

What are the clinical features of enteropathic arthritis?

Answer 2

• Asymmetrical arthritis, predominantly affecting LL joints (knees, ankles) or elbows
• HLA-B27 associated sacroilitis or spondylitis
• Joint symptoms may predate bowel disease and lead to its diagnosis

Question 3

What is the mx of of enteropathic arthritis?

Answer 3

Treat underlying IBD

• SSZ > mesalazine –> helps both bowel and joint disease
• After all, SSZ gets broken down into 5-Asa which is used to treat IBD
• TNFa can help reduce the arthritis

NSAIDs (but may worsen diarrhoea)

If monoarthritis: use intra-articular corticosteroids (as NSAIDs can make diarrhoea worse)