Enteropathic arthritis

Enteropathic arthritis is a form of arthritis associated with the chronic inflammatory bowel diseases (IBD)), ulcerative colitis (UC), and Crohn's disease (CD). This form of arthritis is classified as one of the group of seronegative spondylo-arthropathies, which also includes psoriatic arthritis, reactive arthritis, and idiopathic ankylosing spondylitis (AS). Joint involvement also occurs with other gastrointestinal diseases such as Whipple's disease, celiac disease, and following intestinal bypass surgery for morbid obesity. In these conditions, abnormal bowel permeability and immunologic and genetic influences are probably involved in the pathogenesis of the joint disease, although the exact mechanisms remain uncertain. Articular involvement is the most common extraintestinal manifestation of IBD, with a prevalence of between 2% and 26% in both retrospective [1,2] and prospective studies [3]. The relationship between peripheral arthritis and UC was first described in 1929 [4], but it was not until the late 1950s that the peripheral arthritis associated with 1131) was distinguished from rheumatoid arthritis [5-7]. Joint involvement in enteropathic arthritis has been divided historically into two main patterns: (1) peripheral arthritis, and (2) axial involvement, including sacroiliitis with or without spondylitis similar to idiopathic AS. Other periarticular features can occur, including enthesopathy, tendonitis, and a miscellaneous group including clubbing, periostitis, and granulomatous lesions of joint and bone [8]. Osteoporosis and osteomalacia secondary to IBD and iatrogenic complications can also occur.