Spondyloarthropathy due to Inflammatory Bowel Disease

Aka: Spondyloarthropathy due to Inflammatory Bowel Disease, Crohn's Disease Associated Arthritis, Ulcerative Colitis Associated Arthritis, Colitic Arthritis, Arthritis associated with Ulcerative Colitis, Inflammatory Bowel Disease with Spondyloarthropathy, Arthropathy of Inflammatory Bowel Disease, Enteropathic Arthritis

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II. Pathophysiology

  1. Associated with Inflammatory Bowel Disease
  2. Greater association with Crohn's Disease
  3. No synovial destruction

III. Symptoms

  1. Asymmetric joint involvement
    1. Migratory Arthritis or Monoarticular Arthritis
    2. Lower extremity more often involved
  2. Joints affected
    1. Hip
    2. Ankle
    3. Wrist
    4. Elbow
  3. Low Back Pain with morning stiffness
  4. Associated Spine conditions
    1. Ankylosing Spondylitis
    2. Sacroiliitis
    3. Axial Arthritis
  5. Extra-articular changes
    1. Bilateral Uveitis
    2. Skin changes
      1. Erythema Nodosum
      2. Pyroderma gangrenosum

IV. Management

  1. Avoid NSAIDs if possible
  2. Sulfasalazine
  3. Methotrexate
  4. Azathioprine
  5. Etanercept (TNF-a inhibitor)

V. Course

  1. Does not resolve after proctocolectomy
  2. Often subsides in 6-8 weeks after onset
  3. Often recurrs and may become chronic in 10% of cases

VI. References

  1. Liu in Noble (2001) Primary Care, p. 86-7
  2. Holden (2003) Rheum Dis Clin North Am 29(3): 513-30 [PubMed]

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