Enteropathic arthritis is a type of arthritis that affects the joints and the spine that commonly occurs in conditions, such as Crohn's disease, inflammatory bowel disease and ulcerative colitis. This type of arthritis is classified as a spondylarthropathy. Other spondylarthropathies include psoriatic arthritis, spondylitis and reactive arthritis.
In inflammatory bowel disease patients, about 20 percent develop arthritis. The incidence is higher in patients with Crohn's disease.
Signs and Symptoms
This type of arthritis may present as peripheral arthritis, axial arthritis or mixed. As peripheral arthritis, the pattern is usually asymmetric and affecting four or fewer joints. As axial arthritis, the symptoms are usually stiffness and pain and the back that are similar to ankylosing spondylitis. Gastrointestinal symptoms are also common.
Making the Diagnosis
The patient's doctor will usually start by thoroughly discussing the signs and symptoms the patient is experiencing and then performing a physical examination. The doctor will then often look for signs of anemia and perform a blood test to check the patient's iron levels. Other blood tests may include an ESR and a CRP because when elevated they indicate inflammation.
X-rays are commonly done. The doctor will be looking at the peripheral joints for a lack of erosive changes. He or she will then examine the spinal and sacroiliac joints for a resemblance to ankylosing spondylitis. If there is inflammation present in the sacroiliac joint, this is suggestive of enteropathic arthritis.
Stool testing may be performed, particularly, if the patient is experiencing gastrointestinal symptoms, such as diarrhea and abdominal pain, but has not been diagnosed with any inflammatory bowel conditions. The patient's stool will be examined for infections and blood.
A colonoscopy may be performed to get a more detailed look at the patient's digestive tract. This is most often done when the patient is having gastrointestinal symptoms.
Patients with painful, swollen joints may undergo a synovial fluid aspiration. This involves inserting a needle into the joint to get a fluid sample to examine. This is done to rule out, infection, gout and other possible causes of inflammation.
This type of arthritis is treated in a similar fashion as other spondylarthropathies for joint symptoms. Both the bowel disease and the arthritis have to be treated. Non-steroidal anti-inflammatory drugs often effectively treat the arthritis, but these types of drugs will typically worsen the bowel disease. There is a certain class of medications, known as anti-TNF drugs that are successful for most patients in treating both the arthritis and the bowel disease. Commonly prescribed medications for enteropathic arthritis are anti-TNF drugs include Humira, Remicade and Cimzia.
Minerva, P. MD. (2008). Enteropathic Arthropathies. Retrieved on March 29, 2011 from eMedicine: https://emedicine.medscape.com/article/334746-overview
Quality Health. (2010). Understanding Enteropathic Arthritis. Retrieved on March 29, 2011 from Quality Health: https://www.qualityhealth.com/arthritis-articles/understanding-enteropathic-arthritis