Bowel diseases associated with inflammatory arthritis:
- Idiopathic, inflammatory bowel disease, IBD (ulcerative colitis [UC], Crohn’s
disease) and pouchitis.
- Microscopic colitis (lymphocytic colitis and collagenous colitis).
- Infectious gastroenteritis and pseudomembranous colitis.
- Whipple’s disease.
- Gluten-sensitive enteropathy (celiac disease).
- Intestinal bypass arthritis.
Occurrence of inflammatory peripheral and/or spinal arthritis in
patients with idiopathic IBD:
5% to 10%
10% to 15%
Clinical characteristics of inflammatory peripheral arthritis
associated with idiopathic IBD:
Type 1 (arthritis often
parallels IBD activity): occurs in 4% to 6% of IBD patients, affecting males
and females equally, typically acute in onset (80%), asymmetric (80%), and
pauciarticular (usually involves less than five joints with the knee and ankle
most common). It occurs before or early in the course of the bowel disease and
is strongly associated with flares of IBD and other extraarticular
manifestations (erythema nodosum, uveitis). Most arthritic episodes are
self-limited with 80% resolving within 3 months. This type of arthritis does
not result in radiographic changes or deformities.
Type 2 (arthritis is
independent of IBD activity): is less common occurring in 3% to 4% of IBD
patients. The arthritis tends to be symmetric (80%), polyarticular
(metacarpophalangeal [MCP] joints > knees and ankles > other joints),
runs a course independent of the activity of the inflammatory bowel disease,
and does not correlate with extraarticular manifestations (except uveitis).
Active arthritis is chronic (90%) and episodes of exacerbations and remissions
may continue for years. This type of arthritis can cause erosions and
Approximately 25% of IBD
patients have a combination of extraintestinal
P—pyoderma gangrenosum (<2%
(<10%): more common in UC.
I—inflammatory eye disease
(acute anterior uveitis) (5% to 15%): more common in Crohn’s disease.
N—nodosum (erythema) (<10%
Human leukocyte antigen-B27 (HLA-B27)
occurs more commonly than expected with inflammatory arthritis. 8% of a normal
healthy white population has the HLA-B27 gene, but a patient with IBD who
possesses the HLA-B27 gene has a seven to ten times increased risk of
developing an inflammatory sacroiliitis/spondylitis compared with IBD patients
who are HLA-B27-negative.
Rheumatic problems in IBD patients:
- Achilles enthesitis/plantar fasciitis (enthesopathy).
- Granulomatous lesions of bones and joints.
- Hypertrophic osteoarthropathy (periostitis)
- Psoas abscess or septic hip from fistula formation (Crohn’s
- Osteoporosis and avascular necrosis secondary to medications