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Enteropathic Arthritides

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:



Peripheral arthritis

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 deformities.

Approximately 25% of IBD patients have a combination of extraintestinal manifestations:

P—pyoderma gangrenosum (<2% to 5%).

A—aphthous stomatitis (<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% to 15%).

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 enthesitis
  • Granulomatous lesions of bones and joints.
  • Hypertrophic osteoarthropathy (periostitis)
  • Psoas abscess or septic hip from fistula formation (Crohn’s disease).
  • Osteoporosis and avascular necrosis secondary to medications (i.e., prednisone).
  • Amyloidosis





SpA Imaging


Inflammatory Bowel Diseases, ECCO

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