Inflammatory Bowel Disease—Associated Spondyloarthritis

20% of patients with inflammatory bowel disease have arthritis

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

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

Clinical

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