Arthritis & Inflammatory Intestinal Diseases

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

    • Activity of the joint disease parallels that of the bowel disease

  • Spondylitis

    • Indistinguishable by symptoms or radiograph from axial spondyloarthritis

    • 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 arthritis

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Can be effective for mild arthritis

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

• Tumor necrosis factor inhibitors, Jak inhibitors (tofacitanib, upadacitanib), and anti-IL 12/23 (ustekinumab) can treat both the bowel and joint/axial inflammation