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

2. Inflammatory bowel disease
Ulcerative colitis
Crohn’s disease

3. Inflammatory bowel disease
Intestinal involvement
Extraintestinal involvement

4. Extraintestinal involvement
Arthritis
Aphthous stomatitis
Erythema nodosum
Anterior uveitis
Pyoderma gangrenosum

5. Other rheumatic problems
Achilles tendinitis
Clubbing
Hypertrophic osteoarthropathy
Osteoporosis
Vasculitis
Amyloidosis

9. Musculoskeletal
Peripheral arthritis
Axial arthritis
Both of them

10. 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

11. 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

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

13. Radiology
Soft tissue swelling and effusions without erosions or destruction

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

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

16. 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

17. Lab. test
HLA-B27 : 53 to 75%

18. Radiology
Typical findings of ankylosing spondylitis and bilateral sacroiliitis

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

23. 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

24. 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.

25. 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

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

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

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

29. 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.