Enteropathic Arthritis
by Harvard Medical School
Enteropathic arthritis develops in approximately 9%–20% of people with ulcerative colitis or Crohn's disease, which are types of inflammatory bowel disease. These disorders cause episodes of abdominal pain, diarrhea, and weight loss. When arthritis develops in people with ulcerative colitis or Crohn's disease, it usually affects multiple joints in the arms and legs. About 20% of people with enteropathic arthritis have sacroiliitis, an inflammation of the sacroiliac joints in the lowest region of the back.
Studies show that people with enteropathic arthritis have a hereditary disposition to inflammatory bowel disease, but no specific gene has been discovered to account for this type of arthritis. Inflammatory bowel disease causes ulcers and microscopic abscesses in the colon (in ulcerative colitis) or throughout the intestinal tract (in Crohn's disease). Enteropathic arthritis may result from an immune response to intestinal bacteria that gain access to the body through an inflamed bowel.
- arthritis in multiple joints, usually the knees, ankles, elbows, and wrists, and sometimes in the spine, hips, or shoulders
- worsening of symptoms during inflammatory bowel disease flare-ups
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Your doctor will do a physical examination and ask you about your symptoms and your ulcerative colitis or Crohn's disease. He or she may order imaging and blood tests (see "Diagnosing arthritis").
If you have ulcerative colitis, arthritis often appears during a colitis flare-up and disappears when bowel symptoms subside. It may be difficult to correctly diagnose the type of arthritis in someone with ulcerative colitis, however. Some actually suffer from ankylosing spondylitis, with symptoms that don't fluctuate with colitis symptoms. To further complicate matters, some people diagnosed with ankylosing spondylitis have asymptomatic inflammation of the small intestine, raising the possibility that their disease may actually be enteropathic arthritis.
Physicians treat enteropathic arthritis with medications similar to those used in rheumatoid arthritis, including NSAIDs, sulfasalazine, methotrexate, and anti-TNF medications (see "Medications for rheumatoid arthritis").
Source: from Harvard Health Publications, Copyright © 2008 Harvard University. All rights reserved. Harvard Medical School does not endorse products.
Used with permission of StayWell.
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