Enteropathic Arthritis or Arthritis associated with Inflammatory Bowel Disease is a type of arthritis that can develop in people with an inflammatory bowel disease such as ulcerative colitis or Crohn’s disease.
Enteropathic Arthritis usually affects the joints of the lower limbs and the spine but any joint can be affected. It can also cause debilitating body aches similar to a disease called fibromyalgia. The specific symptoms of Enteropathic Arthritis vary from person to person. Not all people who have an inflammatory bowel disease will get Enteropathic Arthritis.
Some with Enteropathic Arthritis experience a flare of joint pain around the same time that their bowel disease flares. In others the arthritis is not associated with flares of bowel disease.
Enteropathic arthritis typically affects younger people between 15 and 40 years of age, but older people can get it, too. It affects men and women equally. It is more common in people of Jewish descent. Smoking is a known risk factor for both Inflammatory Bowel Disease and Enteropathic Arthriti
There is no diagnostic test that definitively identifies enteropathic arthritis. Diagnosis is usually achieved by confirming the presence of inflammatory bowel disease, and ruling out other types of arthritis.
To confirm or diagnose inflammatory bowel disease, it may be necessary for patients to see a gastroenterologist, a type of doctor that specializes in diseases of the gastrointestinal system.
To make a diagnosis, doctors will take a careful and complete history and perform a thorough physical examination. Based on this information, the doctor will likely order tests like blood tests and scans to confirm the diagnosis.
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About one in five people with an inflammatory bowel disease like Crohn’s disease or ulcerative colitis will develop Enteropathic Arthritis. Most people with inflammatory bowel disease will discover they have Enteropathic Arthritis after they develop body aches or sore joints. Sometimes it is discovered the other way around when some people with arthritis symptoms discover they have inflammatory bowel disease.
Enteropathic arthritis can be very different from one person to another. The symptoms of enteropathic arthritis depend on how the disease presents in each person.
Aches all over the Body (Arthralgia)
The most common presentation of Enteropathic Arthritis causes arthralgia, or aches all over the body. There is no inflammation or swollen joints, but it can be very debilitating. This presentation can be similar to fibromyalgia, a chronic pain disorder. In this case, the joint and muscle pain may be secondary to unrecognized inflammatory bowel disease. The achiness may improve if the bowel disease is adequately treated.
Spine and Sacroiliac (SI) Joint Inflammation
Another presentation of enteropathic arthritis results in inflammation of the spine and sacroiliac joints (the joints between the spine and the pelvis). This causes a stiff, sore back that can be debilitating. This can look a lot like ankylosing spondylitis. While most people with Ankylosing Spondylitis have a gene called HLA-B27, only about half of people with Enteropathic Arthritis carry this gene. In people with this type of Enteropathic Arthritis, adequate control of inflammatory bowel disease may not improve the joint inflammation.
Peripheral (Limb) Joints
Enteropathic arthritis can affect the peripheral (limb) joints in the lower body (ankles, knees, hips) and occasionally the wrists and elbows. This presentation can cause acute (quick onset) pain and joints that flare. Flares of joint pain often happen around the same time the bowel disease flares. In treating this condition, often seeing a local massage therapist for muscle tension, a local personal trainer for muscle strength and a physiotherapist for release and conditioning is a good option. Getting a referral to a rheumatologist or your local pharmacist is also important in dealing with Arthritic conditions.
Less commonly, there can be more chronic (long-term) peripheral arthritis that affects multiple joints including the knees, ankles, elbows, shoulders, wrists or knuckles.
Blood Tests Looking for inflammation: Enteropathic Arthritis is an inflammatory arthritis so these tests are expected to have abnormal results. Common tests include a Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP).
Blood Tests Looking for a Genetic Marker: HLA-B27 is a genetic marker often associated with different types of arthritis. Enteropathic Arthritis patients with this marker are much more likely to have spinal involvement with their disease than those who test negative.
X-Rays: X-rays of the spine can check for involvement of the pelvic joints
Magnetic Resonance Imaging (MRI): MRI imaging can be helpful for doctors to see inflammation in the spine and other joints.
Colonoscopy: A colonoscopy helps determine if Inflammatory Bowel Disease is present. The test involves using a special camera on a flexible, long and thin tube that is inserted into the anus so a doctor can visually inspect the bowels.
The cause of Enteropathic Arthritis is unknown at this time. The disease seems to run in families, which is also typical of inflammatory bowel diseases. An exact gene responsible for enteropathic arthritis has not been identified.
About half of patients with enteropathic arthritis have a gene called HLA-B27. This gene is also commonly found in people with other diseases in the spondyloarthropathy family. However, half of people with enteropathic arthritis do not have this gene.
Another possible cause for Enteropathic Arthritis is that an infection in the bowels triggers inflammatory bowel disease and enteropathic arthritis. An infectious agent has not yet been clearly identified.
In some cases, doctors will use medications that lower blood pressure to help relax the blood vessels if you have severe Raynaud’s. We typically reserve those medications for patients that have very severe symptoms.
If you have Enteropathic Arthritis or you think your Enteropathic Arthritis is getting worse, please speak with your family physician.
Presenter: Dr. Jason Kur, Rheumatologist, Vancouver, BC