Enteropathic Arthritis

Understand enteropathic arthritis

Enteropathic arthritis is a common development in patients who suffer from Crohn's disease. Crohn's is an autoimmune disease that typically presents in a manner similar inflammatory bowel syndrome (IBS). Between 9 and 20 percent of Crohn's patients, and patients with ulcerative colitis, develop enteropathic arthritis. Both ulcerative colitis, and the similar Crohn's disease, cause symptoms including weight loss, diarrhea, and abdominal pain.

The development of enteropathic arthritis in patients already suffering from Crohn’s disease or ulcerative colitis generally affects numerous joints in the arms and legs. In addition to this, around 20% of patients who develop enteropathic arthritis also have sacroiliitis, which is the inflammation of sacroiliac joints, located in the lower back area.

Symptoms of enteropathic arthritis

Enteropathic arthritis is a form of arthritis that can occur in several of your joints. It is particularly common in the knees and ankles, as well as the wrists and elbows. In addition, it can sometimes develop in the shoulders, hips, and spine. Flare-ups of inflammatory bowel syndrome and other bowel-related conditions tend to worsen the symptoms of enteropathic arthritis, increasing the pain felt in the joints and potentially causing new pain to develop in joints that did not previously experience pain.

What causes enteropathic arthritis?

Studies have demonstrated that there is a hereditary disposition for inflammatory bowel syndrome among patients who also have enteropathic arthritis. That being said, at present, there has been no identification of a specific gene causing enteropathic arthritis. Inflammatory bowel syndrome frequently results in the development of microscopic abscesses and ulcers in your colon, in cases of ulcerative colitis.

It can also result in the similar development of ulcers throughout your intestinal tract, in cases of Crohn’s disease. When the bowel is inflamed, the intestinal bacteria present in the gut gains access to the rest of your body in a way that would not normally be possible. It has been theorized that enteropathic arthritis is possibly the result of the immune systems responding to the presence of this bacteria.

As the body reacts to a perceived threat, several other things in the body can be triggered, such as acne. It may be that enteropathic arthritis is a similarly reactive response to this autoimmune function.

The diagnosis of enteropathic arthritis

If your doctor suspects you may have enteropathic arthritis they will perform a complete physical examination. They will also ask you about the symptoms you are experiencing, as well as the nature of your Crohn’s disease or ulcerative colitis. They may then order scans including X-rays and MRI scans, to identify areas that are experiencing arthritis, and perform various blood tests to help diagnose the condition.

It can be tricky to correctly diagnose enteropathic arthritis, as symptoms can present intermittently if you are experiencing flare-ups of irritable bowel syndrome, ulcerative colitis, or Crohn's disease. At times when you are having bowel-related symptoms, you will likely experience the symptoms of arthritis; however, those symptoms may disappear again once the bowel condition settles down.

It's not unusual for patients to cancel appointments to discuss the symptoms of enteropathic arthritis, believing the problem has solved itself, and delay diagnosis for some time. In addition, it can be hard for doctors to correctly diagnose the condition, and determine the exact form of arthritis you are suffering from, if they perform tests at a time when your bowel-related disease is not triggering arthritis.

Similar problems occur for diagnosing patients who have ankylosing spondylitis, as they also suffer from asymptomatic inflammation in their small intestines. It is possible that ankylosing spondylitis could actually be another form of enteropathic arthritis.

Treating enteropathic arthritis

Your doctor will determine the best course of treatment for you based on the specific form of arthritis you have, the manner in which it presents (intermittently or permanently), and any related illnesses you may have, in particular, those related to the bowel.

Typical courses of treatment involve medications, and the most effective treatments are similar to the ones used in the treatment of rheumatoid arthritis. This includes sulfasalazine, NSAIDs, anti-TNF medications, and methotrexate.