Enteropathic Arthropathy IBD INTESTINAL BYPASS ARTHRITIS WHIPPLE'S DISEASE Celiac disease

Inflammatory bowel disease Ulcerative colitis Crohn’s disease

Inflammatory bowel disease Intestinal involvement Extraintestinal involvement

Extraintestinal involvement Arthritis Aphthous stomatitis Erythema nodosum Anterior uveitis Pyoderma gangrenosum

Other rheumatic problems Achilles tendinitis Clubbing Hypertrophic osteoarthropathy Osteoporosis Vasculitis Amyloidosis

Musculoskeletal Peripheral arthritis Axial arthritis Both of them

Peripheral Arthritis Peripheral arthritis : 9 – 30% More likely in patients with large-bowel disease and in those patients with complications Male=female Arthritis may precede symptms of GI especially in children

Peripheral Arthritis Acute arthritis Symmetric, migratory polyarthritis affecting primarily large joints of the lower Associated with a flare-up of the bowel disease Occurs early Is self-limiting Without destruction

Peripheral Arthritis Lab test: RF – HLA-BW62 Synovial fluids have 5000 to 12,000 white blood cells

Radiology Soft tissue swelling and effusions without erosions or destruction

Course Is self-limiting (90% of cases resolve within 6 months) Responds to successful treatment of the bowel disease

Spondylitis Frequency : 1.1 to 43% Spondylitis often precedes IBD M>F The activity of spondylitis dose not correlate with activity of IBD

Clinical features Pain and stiffness in the back and/or buttocks in the morning or after rest Stiffness and pain are often relieved by exercise Physical examination reveals limitation of spinal flexion and reduced chest expansion Some patients may have peripheral arthritis

Lab. test HLA-B27 : 53 to 75%

Radiology Typical findings of ankylosing spondylitis and bilateral sacroiliitis

Treatment Glucocorticoids Anti-tumor necrosis factor Sulfasalazine Colectomy (for ulcerative colitis)

UNDIFFERENTIATED Spndyloarthropathy Have some features of one or more of the spondyloarthropathies but there are not enough evidences to meet criteria for differentiated spondyloarthropathies Are not uncommon usually young adults

UNDIFFERENTIATED Spndyloarthropathy Approximately half the patients with undifferentiated spondyloarthropathy are HLA-B27 positive, and thus the absence of B27 is not useful in establishing or excluding the diagnosis.

Clinical presentations inflammatory synovitis of one knee, Achilles tendinitis, and dactylitis of one digit ("sausage digit"), or sacroiliitis in the absence of other criteria for AS

Course Some cases, the patient subsequently develops IBD or psoriasis or the process eventually meets criteria for ankylosing spondylitis.

juvenile-onset spondyloarthropathy Age : 7-16 M>f Asymmetric, predominantly lower extremity oligoarthritis and enthesitis without extraarticular features is the typical mode of presentation

juvenile-onset spondyloarthropathy SEA syndrome (seronegative, enthesopathy, arthropathy(

juvenile-onset spondyloarthropathy Prevalence of B27:80% Many, but not all, of these patients go on to develop typical ankylosing spondylitis in late adolescence or adulthood.