Inflammatory Bowel Disease—Associated Spondyloarthritis

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

  • 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