Chapter 165: Other Musculoskeletal Disorders

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, and plantar fasciitis. Axial involvement can manifest as spondylitis and/or sacroiliitis (often symmetric). Laboratory findings are nonspecific; rheumatoid factor (RF) absent; HLA-B27 is positive in 70% with IBD and axial disease but <15% with IBD and peripheral arthritis; radiographs of peripheral joints usually normal; axial involvement is often indistinguishable from ankylosing spondylitis.

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 diabetes mellitus, 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.

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, and 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.

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 selected chronic lung or liver disease; congenital heart, lung, or liver disease in children; and idiopathic and familial ...