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Arthritis associated with gastrointestinal disease

INTRODUCTION

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 and Whipple's diseases.

The clinical features of arthritis associated with IBD are discussed in detail here, along with the treatment for synovitis in patients with Crohn's 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".)

Therapy for reactive arthritis (formerly called Reiter syndrome) and Behçet’s and Whipple's diseases are also discussed separately. (See "Reactive arthritis (formerly Reiter syndrome)", section on 'Treatment' and "Treatment of Behçet’s disease" and "Whipple's disease", section on 'Treatment'.)

PREVALENCE AND ASSOCIATED DISEASES

Arthritis occurs in 9 to 53 percent of patients with inflammatory bowel disease (IBD) [1-9]. 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's 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 spondyloarthropathies [10].

ULCERATIVE COLITIS AND CROHN'S DISEASE

Ulcerative colitis and regional enteritis (Crohn's 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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Literature review current through: Jun 2014. | This topic last updated: Jun 16, 2014.
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References
Top
  1. Rudwaleit M, Baeten D. Ankylosing spondylitis and bowel disease. Best Pract Res Clin Rheumatol 2006; 20:451.
  2. Inman RD. Arthritis and enteritis--an interface of protean manifestations. J Rheumatol 1987; 14:406.
  3. Lubrano E, Ciacci C, Ames PR, et al. The arthritis of coeliac disease: prevalence and pattern in 200 adult patients. Br J Rheumatol 1996; 35:1314.
  4. Weiner SR, Clarke J, Taggart N, Utsinger PD. Rheumatic manifestations of inflammatory bowel disease. Semin Arthritis Rheum 1991; 20:353.
  5. Schorr-Lesnick B, Brandt LJ. Selected rheumatologic and dermatologic manifestations of inflammatory bowel disease. Am J Gastroenterol 1988; 83:216.
  6. Scarpa R, del Puente A, D'Arienzo A, et al. The arthritis of ulcerative colitis: clinical and genetic aspects. J Rheumatol 1992; 19:373.
  7. Leirisalo-Repo M, Turunen U, Stenman S, et al. High frequency of silent inflammatory bowel disease in spondylarthropathy. Arthritis Rheum 1994; 37:23.
  8. de Vlam K, Mielants H, Cuvelier C, et al. Spondyloarthropathy is underestimated in inflammatory bowel disease: prevalence and HLA association. J Rheumatol 2000; 27:2860.
  9. Tromm A, May D, Almus E, et al. Cutaneous manifestations in inflammatory bowel disease. Z Gastroenterol 2001; 39:137.
  10. De Keyser F, Elewaut D, De Vos M, et al. Bowel inflammation and the spondyloarthropathies. Rheum Dis Clin North Am 1998; 24:785.
  11. Wordsworth P. Arthritis and inflammatory bowel disease. Curr Rheumatol Rep 2000; 2:87.
  12. Gravallese EM, Kantrowitz FG. Arthritic manifestations of inflammatory bowel disease. Am J Gastroenterol 1988; 83:703.
  13. Peeters H, Vander Cruyssen B, Laukens D, et al. Radiological sacroiliitis, a hallmark of spondylitis, is linked with CARD15 gene polymorphisms in patients with Crohn's disease. Ann Rheum Dis 2004; 63:1131.
  14. Fomberstein B, Yerra N, Pitchumoni CS. Rheumatological complications of GI disorders. Am J Gastroenterol 1996; 91:1090.
  15. McEniff N, Eustace S, McCarthy C, et al. Asymptomatic sacroiliitis in inflammatory bowel disease. Assessment by computed tomography. Clin Imaging 1995; 19:258.
  16. Kitis G, Thompson H, Allan RN. Finger clubbing in inflammatory bowel disease: its prevalence and pathogenesis. Br Med J 1979; 2:825.
  17. De Keyser F, Van Damme N, De Vos M, et al. Opportunities for immune modulation in the spondyloarthropathies with special reference to gut inflammation. Inflamm Res 2000; 49:47.
  18. Rispo A, Scarpa R, Di Girolamo E, et al. Infliximab in the treatment of extra-intestinal manifestations of Crohn's disease. Scand J Rheumatol 2005; 34:387.
  19. Caprilli R, Gassull MA, Escher JC, et al. European evidence based consensus on the diagnosis and management of Crohn's disease: special situations. Gut 2006; 55 Suppl 1:i36.
  20. Fornaciari G, Salvarani C, Beltrami M, et al. Muscoloskeletal manifestations in inflammatory bowel disease. Can J Gastroenterol 2001; 15:399.
  21. Herfarth H, Obermeier F, Andus T, et al. Improvement of arthritis and arthralgia after treatment with infliximab (Remicade) in a German prospective, open-label, multicenter trial in refractory Crohn's disease. Am J Gastroenterol 2002; 97:2688.
  22. Van Bodegraven AA, Peña AS. Treatment of Extraintestinal Manifestations in Inflammatory Bowel Disease. Curr Treat Options Gastroenterol 2003; 6:201.
  23. Smale S, Natt RS, Orchard TR, et al. Inflammatory bowel disease and spondylarthropathy. Arthritis Rheum 2001; 44:2728.
  24. Takeuchi K, Smale S, Premchand P, et al. Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2006; 4:196.
  25. O'Brien J. Nonsteroidal anti-inflammatory drugs in patients with inflammatory bowel disease. Am J Gastroenterol 2000; 95:1859.
  26. Sandborn WJ, Stenson WF, Brynskov J, et al. Safety of celecoxib in patients with ulcerative colitis in remission: a randomized, placebo-controlled, pilot study. Clin Gastroenterol Hepatol 2006; 4:203.
  27. Biancone L, Tosti C, Geremia A, et al. Rofecoxib and early relapse of inflammatory bowel disease: an open-label trial. Aliment Pharmacol Ther 2004; 19:755.
  28. Kirsner JB, Shorter RG. Recent developments in "nonspecific" inflammatory bowel disease (first of two parts). N Engl J Med 1982; 306:775.
  29. Van den Bosch F, Kruithof E, De Vos M, et al. Crohn's disease associated with spondyloarthropathy: effect of TNF-alpha blockade with infliximab on articular symptoms. Lancet 2000; 356:1821.
  30. Generini S, Giacomelli R, Fedi R, et al. Infliximab in spondyloarthropathy associated with Crohn's disease: an open study on the efficacy of inducing and maintaining remission of musculoskeletal and gut manifestations. Ann Rheum Dis 2004; 63:1664.
  31. Moshkowitz M, Oren R, Tishler M, et al. The absorption of low-dose methotrexate in patients with inflammatory bowel disease. Aliment Pharmacol Ther 1997; 11:569.
  32. Marzo-Ortega H, McGonagle D, O'Connor P, Emery P. Efficacy of etanercept for treatment of Crohn's related spondyloarthritis but not colitis. Ann Rheum Dis 2003; 62:74.
  33. Sandborn WJ, Hanauer SB, Katz S, et al. Etanercept for active Crohn's disease: a randomized, double-blind, placebo-controlled trial. Gastroenterology 2001; 121:1088.
  34. De Keyser F, Baeten D, Van den Bosch F, et al. Gut inflammation and spondyloarthropathies. Curr Rheumatol Rep 2002; 4:525.
  35. Schiellerup P, Krogfelt KA, Locht H. A comparison of self-reported joint symptoms following infection with different enteric pathogens: effect of HLA-B27. J Rheumatol 2008; 35:480.
  36. Panush RS, Stroud RM, Webster EM. Food-induced (allergic) arthritis. Inflammatory arthritis exacerbated by milk. Arthritis Rheum 1986; 29:220.
  37. Ratner D, Schneeyour A, Eshel E, Teitler A. Does milk intolerance affect seronegative arthritis in lactase-deficient women? Isr J Med Sci 1985; 21:532.
  38. McGill PE. Rheumatic syndromes associated with parasites. Baillieres Clin Rheumatol 1995; 9:201.
  39. Peng SL. Rheumatic manifestations of parasitic diseases. Semin Arthritis Rheum 2002; 31:228.
  40. McGill PE. Geographically specific infections and arthritis, including rheumatic syndromes associated with certain fungi and parasites, Brucella species and Mycobacterium leprae. Best Pract Res Clin Rheumatol 2003; 17:289.
  41. Baloch HM, Armstrong DT, Pulling TM, Miller LM. Hookworm-associated reactive spondyloarthritis. Arthritis Rheumatol 2014; 66:578.