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Chapter: Medicine and surgery: Musculoskeletal system

Inflammatory bowel disease related arthritis - Seronegative arthritides (spondyloarthropathies)

An enteropathic arthritis, sacroiliitis, ankylosing spondylitis or rarely hypertrophic osteoarthritis in association with ulcerative colitis or Crohn’s disease. - Definition, Incidence, Age, Sex, Aetiology, Pathophysiology, Clinical features, Complications, Investigations, Management, Prognosis.

Inflammatory bowel disease related arthritis

 

Definition

 

An enteropathic arthritis, sacroiliitis, ankylosing spondylitis or rarely hypertrophic osteoarthritis in association with ulcerative colitis or Crohn’s disease.

 

Prevalence

 

10% of ulcerative colitis patients and 15–20% of Crohn’s patients.

 

Age

 

Commonest at 20–45 years.

 

Sex

 

1:1

 

Aetiology

 

The aetiology is unknown but the synovitis may occur in response to bacterial antigens that have passed through the damaged gut wall. Enteropathic arthritis is a seronegative non-erosive synovitis. Sacroiliitis is related to the presence of HLA B27

 

Clinical features

 

An acute, self-limiting, asymmetrical non-deforming arthritis usually affecting knees or ankles. Treatment of the inflammatory bowel disease leads to resolution of arthritis.

 

Management

 

Inflammatory bowel disease is treated as normal. Use of nonsteroidal anti-inflammatory drugs for treatment of joint pain may make diarrhoea worse. Intra-articular steroid injections may be of value.

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