What Is Enteropathic Arthritis?
"Enteropathy" refers to any disease related to the intestines. Enteropathic arthritis is an inflammatory condition affecting the spine and other joints that commonly occurs in the inflammatory bowel diseases, Crohn's disease and ulcerative colitis. Inflammatory arthritis associated with other enteropathic diseases (like celiac disease and Whipple's disease) are not generally included in "enteropathic arthritis."
Who Develops Enteropathic Arthritis?
Arthritis occurs in up to 20% of patients with inflammatory bowel disease -- with higher prevalence among Crohn's disease patients than ulcerative colitis patients.
In enteropathic arthritis, the arthritis symptoms can precede the gastrointestinal symptoms for a long period of time. Until the gastrointestinal symptoms are apparent, the arthritis is often classified as Undifferentiated Spondyloarthritis. Most people with enteropathic arthritis, however, have already been diagnosed with one of the inflammatory bowel diseases.
What Are the Symptoms of Enteropathic Arthritis?
Enteropathic arthritis may occur as axial arthritis, peripheral arthritis, or mixed. As axial arthritis, symptoms of back pain and stiffness are like that of ankylosing spondylitis and may precede gastointestinal symptoms. As peripheral arthritis, there is typically a pattern of pauciarticular (4 or fewer joints), and asymmetric arthritis (affected joints not on same side). The gastrointestinal problems can occur at the same time as arthritis -- or arthritis can occur before bowel disease.
How Is Enteropathic Arthritis Diagnosed?
A frank discussion with your doctor about all of your symptoms is the place to start. Typically doctors do tests to look for:
- elevated CRP and ESR indicative of inflammation
- lack of erosive changes on x-ray of peripheral joints
- sacroliliac and spine x-rays that resemble ankylosing spondylitis
How Is Enteropathic Arthritis Treated?
Enteropathic arthritis is treated much the same as other spondyloarthropathies for joint symptoms. The problem is that both conditions - arthritis plus bowel disease -- must be dealt with. NSAIDs which effectively treat arthritis may make bowel disease worse. The anti-TNF drugs Remicade (infliximab), Humira (adalimumab) and Cimzia (certolizumab pegol) have been successfully used to treat inflammatory bowel disease while also being effective for arthritis.
Enteropathic Spondyloarthritis. Primer on the Rheumatic Diseases. Thirteenth edition. Published by Arthritis Foundation.