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Key Features

  • 20% of patients with inflammatory bowel disease have arthritis

  • Arthritis complicates Crohn disease somewhat more frequently than it does ulcerative colitis

Clinical Findings

  • Two distinct forms of arthritis occur

    • Peripheral arthritis—usually a nondeforming asymmetric oligoarthritis of large joints—in which the activity of the joint disease parallels that of the bowel disease

    • Spondylitis that is indistinguishable by symptoms or radiograph from ankylosing spondylitis and follows a course independent of the bowel disease. About 50% of these patients are HLA-B27–positive

  • About two-thirds of patients with Whipple disease experience arthralgia or arthritis, most often an episodic, large-joint polyarthritis. The arthritis usually precedes gastrointestinal manifestations by years and often resolves as the diarrhea develops

  • Differential diagnosis

    • Reactive arthritis (Reiter syndrome)

    • Ankylosing spondylitis

    • Psoriatic arthritis

    • Whipple disease

Diagnosis

  • Clinical

Treatment

  • Controlling the intestinal inflammation usually eliminates the peripheral arthritis

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

    • Can be effective when the arthritis is mild

    • Must be used cautiously because they can exacerbate inflammatory bowel disease

  • Tumor necrosis factor (TNF) inhibitors are effective both for the bowel and the joints

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