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Enteropathic Arthritis: A Clinical Overview, Diagnosis, Physical Presentations, Investigations And Management

Updated on February 13, 2014

Arthritis Associated With Inflammatory Bowel Disease

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Arthritis associated with chronic inflammatory disease of bowel

A heterogenous group of arthritic syndromes develop secondary to primary lesions in the gastrointestinal tract. The primary gastrointestinal disorders leading to arthritis are:

  1. Chronic inflammatory bowel diseases such as ulcerative colitis, Crohn’s disease (regional ileitis) and Whipple’s disease (intestinal lipodystrophy);
  2. Acute infective disorders such as salmonellosis, bacterial dysenteries, and yersinia enterocilitica infection;
  3. Intestinal bypass surgery; and
  4. Gut associated neoplasms which produce arthritis as paraneoplastic manifestations.

Arthritis associated with chronic inflammatory disease of bowel

Even though ulcerative colitis, Crohn’s disease and Whipple’s disease are separate entities, arthritis produced by all the three are similar clinically. Two types are seen:

  1. A peripheral polyarthritis, and
  2. Ankylosing spondylitis with sacroilitis.

The peripheral arthropathy manifests as asymmetric affection of the major joints of the lower limbs. Distal interphalangeal joints may be affected. The arthritis is self-limiting and residual damage is unusual. With subsidence of the intestinal lesion, the arthritis also subsides. A clinical picture indentical with idiopathic ankylosing spondylitis may develop in some cases but there is no male preponderance. Unlike the peripheral arthritic syndrome, the spondylitic variety arthritic syndrome, the spondylitic variety does not bear any relation to the severity or extent of the bowel disease.

Investigations: Neither the synovial fluid nor the synovial biopsy show diagnostic features. Radiology of the joints remains essentially normal except for the soft tissue swelling and minimal osteoporosis. The diagnosis is based on the clinical picture, temporal relation with bowel disease and exclusion of other forms of arthritis.

Management: Since the peripheral type of arthritis is self-limiting, only symptomatic and supportive measures are required for the joint disease. Treatment is directed towards the bowel disorder. In the spondylitic type, line of management is similar to that of idiopathic ankylosing spondylitis.

Arthritis Associated With Infective Disorders Of The Intestines

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Other types of enteropathic arthritis

Infective disorders of the intestines: A migratory polyarthritis may develop up to three weeks after the occurrence of baciliary dysentery, Salmonella infections and Tersinia enterocolitica infection. This is an immunologically-mediated reactive arthropathy.

Gastrointestinal bypass surgery: Jejunocolic or jejunoileal anastomosis done as a therapeutic measure for severe obesity may be followed by a polyarthritic syndrome 2- 3 months later. Restoration of normal bowel anatomy clears the arthropathy.

Arthritis associated with malignancies of the gastrointestinal tract may precede or accompany the neoplasm. Removal of the tumour clears the joint lesions also.

Psoriatic Athropathy

Joints may be affected in psoriasis in one of the following ways:

  1. Predominantly distal arthritis involving the interphalangeal joints;
  2. Classical arthritis mutilans with digital telescoping and sacroiliac involvement;
  3. Arthritis closely resembling rheumatoid arthritis but with asymmetrical involvement and negative serology; and
  4. Spondylitis with or without peripheral arthritis.

Clinical features: Pain and disability are less severe than in rheumatoid arthritis. Psoriatic lesions may be demonstrable in the skin or nails along with the arthritis. Rarely, the joint lesion may precede or follow the skin lesion and in such cases diagnosis may be presumptive for long periods. Involvement of the distal interphalangeal joints has to be distinguished from rheumatoid arthritis, Osteoarthritis, hypertrophic osteoarthropathy and enteropathic arthropathy.

Management: Psoriatic arthropathy is managed on the same lines as rheumatoid arthritis but chloroquine and gold are contraindicated due to the high incidence of exfoliative dermatitis.

© 2014 Funom Theophilus Makama

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    • married2medicine profile image
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      Funom Theophilus Makama 3 years ago from Europe

      Oh! You've made my day cyberShellyey... Thanks a lot

    • CyberShelley profile image

      Shelley Watson 3 years ago

      A very informative, in-depth article around this very painful disease. Up, interesting and useful.