MANUAL MINORS
Enteropathic arthropathies are a group of inflammatory joint diseases associated with inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis. These conditions affect both peripheral joints and the spine, causing pain, swelling, and joint stiffness.
Joint inflammation generally occurs in parallel with intestinal disease activity and is more common in the lower limb joints and spine (spondylitis).
Diagnosis
Diagnosis is based on the temporal relationship between joint symptoms and inflammatory bowel disease. Patients with Crohn’s disease or ulcerative colitis may present with peripheral arthritis (mainly in the knees, ankles, and hips) or ankylosing spondylitis. Imaging studies, such as X-rays or MRIs, may show sacroiliitis or joint erosions.
Laboratory tests include elevated acute-phase reactants (ESR and CRP) during flares, and tests are usually negative for rheumatoid factor and anti-CCP antibodies. The HLA-B27 antigen is frequently present in cases with axial involvement.
Differential Diagnosis
Condition | Distinctive Features |
|---|---|
Ankylosing spondylitis | Inflammatory low back pain, morning stiffness, bilateral sacroiliitis, strong association with HLA-B27. |
Reactive arthritis | Asymmetric post-infectious arthritis, preceded by gastrointestinal or genitourinary infection. |
Psoriatic arthritis | Skin involvement with scaly, erythematous plaques, nail changes, dactylitis. |
Rheumatoid arthritis | Symmetrical polyarthritis, small joints affected, positive serological tests (RF, anti-CCP). |
Gout | Acute attacks, urate crystals in synovial fluid, usually monoarticular. |
Emergency Management
Emergency management of enteropathic arthropathies focuses on controlling pain and inflammation. NSAIDs are effective for relieving joint symptoms but should be used cautiously, as they can worsen gastrointestinal symptoms in patients with inflammatory bowel disease.
In severe exacerbations, systemic or intra-articular corticosteroids may be used. If there is significant joint or extra-articular involvement, referral for specialised care is necessary.
Definitive Treatment
Long-term treatment includes therapy targeting both the inflammatory bowel disease and joint symptoms. Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate or sulfasalazine, can be effective.
Biologic agents, particularly TNF inhibitors (infliximab, adalimumab), are useful for treating both IBD and joint manifestations. In patients with axial involvement, physiotherapy exercises are essential to preserve spinal mobility and prevent stiffness.
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