Arthritis associated with gastrointestinal disease
- Filip Van den Bosch, MD, PhD
Filip Van den Bosch, MD, PhD
- Rheumatology Head-of-Clinic
- Ghent University Hospital
Arthritis is a recognized extraintestinal manifestation of several illnesses and conditions, including inflammatory bowel disease (IBD), bacterial infections of the gut, gluten-sensitive enteropathy (celiac disease), various parasitic infections, and pseudomembranous colitis; and following intestinal bypass surgery. Other illnesses have a propensity for causing inflammation of joints and the gut. Examples discussed in this review include Behçet’s syndrome and Whipple’s disease.
The clinical features of arthritis associated with IBD are discussed in detail here, along with the treatment for synovitis in patients with Crohn disease and ulcerative colitis. The pathogenesis and treatment of IBD are discussed separately. (See "Mechanisms for the induction of rheumatic symptoms by gastrointestinal disease" and "Immune and microbial mechanisms in the pathogenesis of inflammatory bowel disease" and "Overview of the medical management of mild to moderate Crohn disease in adults" and "Management of severe ulcerative colitis in adults".)
Therapy for reactive arthritis (formerly called Reiter syndrome) and Behçet’s syndrome and Whipple’s disease are also discussed separately. (See "Reactive arthritis", section on 'Treatment' and "Treatment of Behçet’s syndrome" and "Whipple's disease", section on 'Treatment'.)
PREVALENCE AND ASSOCIATED DISEASES
Arthritis occurs in 6 to 46 percent of patients with inflammatory bowel disease (IBD) [1-7]. Arthritis is somewhat more likely to occur in patients with large-bowel disease and in those patients with complications such as abscesses, pseudomembranous polyposis, perianal disease, massive hemorrhage, erythema nodosum, stomatitis, uveitis, and pyoderma gangrenosum. Among patients with Crohn disease, those with colonic involvement are at higher risk of developing synovitis than those with isolated small bowel disease. Males and females are affected equally. Both children and adults are at risk for this complication of IBD. In addition, subclinical gut inflammation, documented by endoscopy, has been described in up to two-thirds of patients with spondyloarthritides , a finding that was confirmed in a new prospective cohort of spondyloarthritis (SpA) patients, classified according to the Assessment in SpondyloArthritis international Society (ASAS) criteria .
ULCERATIVE COLITIS AND CROHN DISEASE
Ulcerative colitis and regional enteritis (Crohn disease) are the most frequently encountered types of idiopathic inflammatory bowel disease (IBD) that are associated with arthritis or spondylitis and are discussed first. Other disorders associated with joint pain and/or inflammation are discussed later. (See 'Other diseases with bowel and joint involvement' below.)
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- PREVALENCE AND ASSOCIATED DISEASES
- ULCERATIVE COLITIS AND CROHN DISEASE
- Clinical manifestations
- - Spondylitis and sacroiliitis
- - Type I arthropathy
- - Type II arthropathy
- Laboratory findings
- Radiographic findings
- - Differential diagnosis
- - Peripheral arthritis
- - Recommendations
- Spondylitis and sacroiliitis
- - Recommendations
- OTHER DISEASES WITH BOWEL AND JOINT INVOLVEMENT
- Reactive arthritis
- Whipple's disease
- Behçet's syndrome
- Celiac disease
- Intestinal bypass arthritis
- Parasitic rheumatism
- Pseudomembranous colitis
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS