Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 20-34: Inflammatory Bowel Disease—Associated Spondyloarthritis + Key Features Download Section PDF Listen +++ ++ 20% of patients with inflammatory bowel disease have arthritis Arthritis complicates Crohn disease somewhat more frequently than it does ulcerative colitis + Clinical Findings Download Section PDF Listen +++ ++ 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 Ankylosing spondylitis Psoriatic arthritis Whipple disease + Diagnosis Download Section PDF Listen +++ ++ Clinical + Treatment Download Section PDF Listen +++ ++ 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