An Overview of Enteropathic Arthritis

Joint Symptoms Combined With Gastrointestinal Problems

Man sitting on bed with backache
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Enteropathic arthritis is an inflammatory condition affecting the spine and other joints that commonly occurs in the inflammatory bowel diseases, Crohn's disease and ulcerative colitis. Inflammatory arthritis associated with other enteropathic diseases, such as like celiac disease and Whipple's disease, are not generally included in "enteropathic arthritis". Enteropathic arthritis is classified as one of the spondyloarthropathies.

Other spondyloarthropathies include ankylosing spondylitis, psoriatic arthritis, and reactive arthritis. "Enteropathy" refers to any disease related to the intestines.

Who Develops Enteropathic Arthritis?

Arthritis occurs in up to 20 percent of people who have inflammatory bowel disease, with higher prevalence among those with Crohn's disease compared to those with ulcerative colitis. In enteropathic arthritis, the arthritis symptoms can precede the gastrointestinal symptoms for a long period of time. Until the gastrointestinal symptoms are apparent, the arthritis is often classified as Undifferentiated Spondyloarthritis. Most people with enteropathic arthritis, however, have already been diagnosed with one of the inflammatory bowel diseases.

Study results published in Clinical Rheumatology suggested that IL-23, a biomarker, is higher in people with inflammatory bowel disease, especially Crohn's disease, and it is higher in those with peripheral and/or axial arthritis compared to controls.

More studies are needed, but it may be a significant finding that could lead to a new therapeutic target.

What Are the Symptoms of Enteropathic Arthritis?

Enteropathic arthritis may occur as axial arthritis, peripheral arthritis, or mixed. As axial arthritis, symptoms of back pain and stiffness resemble ankylosing spondylitis and may precede gastrointestinal symptoms.

As peripheral arthritis, there is typically a pattern of pauciarticular (4 or fewer joints involved) and asymmetric arthritis (affected joints are not on the same side of the body). The gastrointestinal problems can occur at the same time as arthritis or arthritis can occur before bowel disease.

How Is Enteropathic Arthritis Diagnosed?

An open and honest discussion with your doctor about all of your symptoms is the place to start. Typically doctors do tests to look for:

  • anemia
  • elevated CRP and ESR indicative of inflammation
  • lack of erosive changes on an x-ray of peripheral joints
  • sacroiliac and spine x-rays that resemble ankylosing spondylitis

One study, published in Autoimmunity Reviews, assessed the performance of a Gastrointestinal and Rheumatologic Clinic. The study revealed that people with spondylitis had a higher prevalence of other autoimmune extra-intestinal manifestations and received more treatment with TNF blockers than people with inflammatory bowel disease. Those who had symptom onset of enteropathic spondylitis in the decade between 1980-1990 and 1991-2001 experienced a significant delay in diagnosis. It has improved considerably. People who had disease onset of enteropathic spondylitis between 2002-2012 had reduced delay in diagnosis.

It seems evident that clinics with a multidisciplinary approach, focusing on both the joint symptoms and gastrointestinal symptoms, is optimal for this particular diagnosis.

How Is Enteropathic Arthritis Treated?

Enteropathic arthritis is treated much the same as other spondyloarthropathies for joint symptoms. The problem is that both conditions must be dealt with—the arthritis as well as the bowel disease—but as NSAIDs may effectively treat arthritis, the drugs may make bowel disease worse. TNF inhibitors, which include Remicade (infliximab), Humira (adalimumab) and Cimzia (certolizumab pegol) have been successfully used to treat inflammatory bowel disease and they are also effective for inflammatory arthritis.

A Word From Verywell

According to the Spondylitis Association of America, the course and severity of enteropathic arthritis varies from person to person. While disease flares in enteropathic arthritis tend to be self-limiting and subside after six weeks, recurrence is common. And, the arthritis portion of enteropathic arthritis may become chronic and it may be associated with joint destruction. There is no known cure for enteropathic arthritis, but medications help to manage both the bowel and arthritic components of enteropathic arthritis.

Sources:

Enteropathic Spondyloarthritis. Primer on the Rheumatic Diseases. Thirteenth edition. Published by Arthritis Foundation.

Gheita, TA. Involvement of IL-23 in enteropathic arthritis patients with inflammatory bowel disease: preliminary results. Clinical Rheumatology. 2014 May;33(5):713-7.

Conigliaro P.,  et al. Impact of a multidisciplinary approach in enteropathic spondyloarthritis patients. Autoimmunity Reviews. 2016 Feb;15(2):184-90.

Overview of Enteropathic Arthritis/Arthritis Associated With Inflammatory Bowel Disease. Spondylitis Association of America.

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