Inflammatory Bowel Disease Arthropathy[1]

8/3/2019 Inflammatory Bowel Disease Arthropathy[1]

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INFLAMMATORY BOWELDISEASE ARTHROPATHY

Wala, Weam and Wafa



Introduction

Arthritis is the most common extra-intestinalmanifestation of inflammatory bowel disease (IBD)

It has a significant impact on morbidity and qualityof life.

The mechanisms surrounding the development ofarthritis in IBD remain unclear.

Males and females are affected equally. Bothchildren and adults are at risk for this complicationof IBD.



Enteropathic arthritis

Acute inflammatory arthritis that occurs in 12% ofpatients with ulcerative colitis and 20% of patientswit Crohn·s disease

Large lower limbs are most affected (knees< anklesand hips) but the wrists and small joints of thefingers and toes can also be affected.

The arthritis symptoms coincide with the symptomsof the IBD.



Type I Arthropathy

Five percent of IBD patients develop type I arthropathy.

Joint symptoms may occur prior to the onset of symptomssuggestive of bowel disease.



The peripheral arthritis tends to be:acute

Pauci-articular (affecting six or fewer joints)

often associated with flares of the bowel disease,

occurs early in the course of the bowel disease

Self-limiting (90 percent under 6 months)

does not result in joint deformitiesthe knee is most commonly affected



Type II Arthropathy

Type II arthropathy affects 3 to 4 percent ofpatients with IBD. Articular involvement rarelyprecedes the diagnosis of IBD and joint symptomstypically do not parallel the activity of boweldisease.

Patients usually have polyarticular disease, with

metacarpophalangeal (MCP) joints beingparticularly involved.



Other joints (knees, ankles, elbows, shoulders, wrists,proximal interphalangeal (PIP), andmetatarsophalangeal (MTP) joints) are less oftenaffected.Approximately one half of the patients with IBDhave migratory arthritis.

Active synovitis may persist for months, and mayrecur repeatedly. Episodes of exacerbations andremissions may continue for years.



Sacroiliitis and Ankylosing spondylitis

Unlike enteropathic arthritis it doesn·t coincide withthe activity of the bowel disease.

More difficuilt to treat than peripheral arthropathy.

Sometimes can be found coincidently and notalways related to the IBD.



Seronegative Spondylopathy with Crohn·s disease



Investigations and Diagnosis

HLA-B27 is found in 50 to 75 percent of thepatients with axial arthritis.

Synovial fluids may yield from 5000 to 12,000white blood cells per microliter, predominantlypolymorphonuclear leukocytes.



Radiographs of thespine and pelvis mayshow typical findings ofankylosing spondylitis

and sacroiliitis.There is nopathognomonic findingto confirm the clinicalsuspicion of arthritis dueto IBD.The diagnosis remainslargely one of exclusion.



Treatment

Effective treatment of the underlying IBD is oftenhelpful in controlling the peripheral arthritis.

Axial arthritis is more problematic since it doesn·tcorrelate with IBD regression.

NSAIDs may relieve the arthritic symptoms, but mayhave an adverse effect on the IBD and are

therefore best avoided!!!



Drugs that may be helpful for both bowel and jointinflammation include:

Sulfasalazine

Azathioprine

6-mercaptopurine

Methotrexate

Glucocorticoidstumor necrosis factor (TNF) inhibitors

Inflammatory Bowel Disease Arthropathy[1]

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