Enteropathic Arthritis: Understanding the Basic Facts

Joint Symptoms Combined With Gastrointestinal Problems

Man sitting on bed with backache
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"Enteropathy" refers to any disease related to the intestines. 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 (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.

Who Develops Enteropathic Arthritis?

Arthritis occurs in up to 20 percent of inflammatory bowel disease patients with higher prevalence among Crohn's disease patients than ulcerative colitis patients. 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 patients 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) and asymmetric arthritis (affected joints not on the same side). The gastrointestinal problems can occur at the same time as arthritis or arthritis can occur before bowel disease.

How Is Enteropathic Arthritis Diagnosed?

A frank 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 patients with spondylitis had a higher prevalence of other autoimmune extra-intestinal manifestations and received more treatment with TNF blockers than patients with inflammatory bowel disease. Those who had symptom onset of enteropathic spondylitis in the decade between 1980 and 1990 and 1991-2001 experienced a significant delay in diagnosis. It has improved considerably. Patients with 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.

How Is Enteropathic Arthritis Treated?

Enteropathic arthritis is treated much the same as other spondyloarthropathies for joint symptoms. The problem is that both conditions—arthritis as well as bowel disease—must be dealt with, but NSAIDs which effectively treat arthritis may make bowel disease worse. The anti-TNF drugs, 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.


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

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

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

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