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ENTEROPATHIC ARTHRITIS

Both peripheral and axial arthritis may be associated with the inflammatory bowel diseases (IBD) of ulcerative colitis or Crohn's disease. The arthritis can occur after or before the onset of intestinal symptoms. Peripheral arthritis is episodic and asymmetric; it most frequently affects knee and ankle. Attacks usually subside within several weeks and characteristically resolve completely without residual joint damage. Enthesitis (inflammation at insertion of tendons and ligaments into bone) can occur with manifestations of "sausage digit," Achilles tendinitis, plantar fasciitis. Axial involvement can manifest as spondylitis and/or sacroiliitis (often symmetric). Laboratory findings are nonspecific; rheumatoid factor (RF) absent; only 30–70% HLA-B27 positive; radiographs of peripheral joints usually normal; axial involvement is often indistinguishable from ankylosing spondylitis.

TREATMENT Enteropathic Arthritis

Directed at underlying IBD; NSAIDs may alleviate joint symptoms but can precipitate flares of IBD; sulfasalazine may benefit peripheral arthritis; treatment of Crohn's disease with infliximab or adalimumab has improved arthritis.

WHIPPLE'S DISEASE

Characterized by arthritis in up to 75% of pts that usually precedes appearance of other symptoms. Usually oligo- or polyarticular, symmetric, transient but may become chronic. Joint manifestations respond to antibiotic therapy.

NEUROPATHIC JOINT DISEASE

Also known as Charcot's joint, this is a severe destructive arthropathy that occurs in joints deprived of pain and position sense; may occur in diabetic neuropathy, tabes dorsalis, syringomyelia, amyloidosis, spinal cord or peripheral nerve injury. Distribution depends on the underlying joint disease. Joint effusions are usually noninflammatory but can be hemorrhagic. Radiographs can reveal either bone resorption or new bone formation with bone dislocation and fragmentation.

TREATMENT Neuropathic Joint Disease

Stabilization of joint; surgical fusion may improve function.

RELAPSING POLYCHONDRITIS

An idiopathic disorder characterized by recurrent inflammation of cartilaginous structures. Cardinal manifestations include ear and nose involvement with floppy ear and saddlenose deformities, inflammation and collapse of tracheal and bronchial cartilaginous rings, asymmetric episodic nondeforming polyarthritis. Other features can include scleritis, conjunctivitis, iritis, keratitis, aortic regurgitation, glomerulonephritis, and other features of systemic vasculitis. Onset is frequently abrupt, with the appearance of 1–2 sites of cartilaginous inflammation. Diagnosis is made clinically and may be confirmed by biopsy of affected cartilage.

TREATMENT Relapsing Polychondritis

Glucocorticoids (prednisone 40–60 mg/d with subsequent taper) may suppress acute features and reduce the severity/frequency of recurrences. Cytotoxic agents should be reserved for unresponsive disease or for pts who require high glucocorticoid doses. When airway obstruction is severe, tracheostomy is required.

HYPERTROPHIC OSTEOARTHROPATHY

Syndrome consisting of periosteal new bone formation, digital clubbing, and arthritis. Most commonly seen in association with lung carcinoma but, also occurs with chronic lung or liver disease; congenital heart, lung, or liver disease in children; and idiopathic and familial forms. Symptoms include burning and aching pain most pronounced in distal extremities. Radiographs show periosteal thickening with new ...

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