Enteropathic Arthropathies Workup

  • Author: Pierre Minerva, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Mar 29, 2012
 

Approach Considerations

Lab studies reveal the following:

  • Complete blood count (CBC) - May reveal iron deficiency anemia, leukocytosis, and thrombocytosis
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) concentration - Usually elevated
  • Rheumatoid factor (RF) - Absent
  • Synovial fluid analysis - Shows mild to moderate inflammatory fluid, mononuclear cell predominance (often), negative cultures, and no crystals
  • Antiendomysial and antitransglutaminase antibodies - Usually elevated in celiac disease

Although more than 90% of patients with ankylosing spondylitis (AS) alone carry the HLA-B27 gene, it is found in only 30-70% of those with IBD-associated AS. However, nearly all IBD patients with a positive HLA-B27 antigen develop AS.

Anti-Saccharomyces cerevisiae antibodies (ASCA) may be helpful in the diagnosis of inflammatory bowel disease (IBD).[3]

Procedures

Consider arthrocentesis if joint swelling or effusion is present, especially if concern about infection or crystal disease exists.

Consider small-bowel biopsy upon clinical suspicion for Whipple disease or for celiac disease when serology findings are equivocal.

Endoscopy and biopsy may reveal subclinical bowel inflammation in patients with spondyloarthropathy.[4]

Next

Imaging Studies

Radiography

The anteroposterior pelvis or the sacroiliac joints show bilateral sacroiliitis, usually symmetrical when associated with inflammatory bowel disease (IBD). The spine shows syndesmophytes and apophyseal joint involvement. Bamboo spine is uncommon. Erosive disease is uncommon in the peripheral joints, but bony spurs at the heel (enthesitis) may be observed.

MRI

Magnetic resonance imaging (MRI) is useful for early detection of spinal and sacroiliac lesions characteristic of the spondyloarthropathies.

Bone scintigraphy

This study may show increased uptake in a typical pauciarticular, asymmetrical joint pattern.

Ultrasonography

Ultrasonography may be useful in identifying early soft-tissue pathology, such as tenosynovitis.

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Contributor Information and Disclosures
Author

Pierre Minerva, MD  Consulting Staff, Department of Rheumatology, Bryn Mawr Medical Specialists Association; Consulting Staff, Department of Rheumatology, Bryn Mawr Hospital, Lankenay Hospital, Paoli Hospital

Pierre Minerva, MD is a member of the following medical societies: American College of Rheumatology

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

Additional Contributors

Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology

Disclosure: Abbott Honoraria Speaking and teaching; Centocor Consulting fee Consulting; Genentech Grant/research funds Other; HGS/GSK Honoraria Speaking and teaching; Omnicare Consulting fee Consulting; Pfizer Honoraria Speaking and teaching; Roche Speaking and teaching; Savient Honoraria Speaking and teaching; UCB Honoraria Speaking and teaching

Kristine M Lohr, MD, MS Professor, Department of Internal Medicine, Center for the Advancement of Women's Health and Division of Rheumatology, Director, Rheumatology Training Program, University of Kentucky College of Medicine

Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Bourikas LA, Papadakis KA. Musculoskeletal Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis. Dec 2009;15(12):1915-24. [Medline].

  2. Orchard TR, Wordsworth BP, Jewell DP. Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut. Mar 1998;42(3):387-91. [Medline]. [Full Text].

  3. Hoffman IE, Demetter P, Peeters M, et al. Anti-saccharomyces cerevisiae IgA antibodies are raised in ankylosing spondylitis and undifferentiated spondyloarthropathy. Ann Rheum Dis. May 2003;62(5):455-9. [Medline].

  4. Taddio A, Simonini G, Lionetti P, Lepore L, Martelossi S, Ventura A, et al. Usefulness of wireless capsule endoscopy for detecting inflammatory bowel disease in children presenting with arthropathy. Eur J Pediatr. Oct 2011;170(10):1343-7. [Medline].

  5. Takeuchi K, Smale S, Premchand P, Maiden L, Sherwood R, Thjodleifsson B. Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. Feb 2006;4(2):196-202. [Medline].

  6. Sandborn WJ, Stenson WF, Brynskov J, Lorenz RG, Steidle GM, Robbins JL. Safety of celecoxib in patients with ulcerative colitis in remission: a randomized, placebo-controlled, pilot study. Clin Gastroenterol Hepatol. Feb 2006;4(2):203-11. [Medline].

  7. Mahadevan U, Loftus EV Jr, Tremaine WJ, Sandborn WJ. Safety of selective cyclooxygenase-2 inhibitors in inflammatory bowel disease. Am J Gastroenterol. Apr 2002;97(4):910-4. [Medline].

  8. Clegg DO, Reda DJ, Abdellatif M. Comparison of sulfasalazine and placebo for the treatment of axial and peripheral articular manifestations of the seronegative spondylarthropathies: a Department of Veterans Affairs cooperative study. Arthritis Rheum. Nov 1999;42(11):2325-9. [Medline].

  9. Generini S, Giacomelli R, Fedi R, et al. Infliximab in spondyloarthropathy associated with Crohn's disease: an open study on the efficacy of inducing and maintaining remission of musculoskeletal and gut manifestations. Ann Rheum Dis. Dec 2004;63(12):1664-9. [Medline].

  10. Van Den Bosch F, Kruithof E, Baeten D, et al. Randomized double-blind comparison of chimeric monoclonal antibody to tumor necrosis factor alpha (infliximab) versus placebo in active spondylarthropathy. Arthritis Rheum. Mar 2002;46(3):755-65. [Medline].

  11. Fiehn C, Vay S. Induction of inflammatory bowel disease flares by golimumab: report of three patients with enteropathic spondylarthritis or ankylosing spondylitis and comorbid colitis. Arthritis Rheum. Nov 2011;63(11):3640-1. [Medline].

  12. Barrie A, Regueiro M. Biologic therapy in the management of extraintestinal manifestations of inflammatory bowel disease. Inflamm Bowel Dis. Nov 2007;13(11):1424-9. [Medline].

  13. Braun J, Baraliakos X, Listing J, Davis J, van der Heijde D, Haibel H, et al. Differences in the incidence of flares or new onset of inflammatory bowel diseases in patients with ankylosing spondylitis exposed to therapy with anti-tumor necrosis factor alpha agents. Arthritis Rheum. May 15 2007;57(4):639-47. [Medline].

  14. Brophy S, Pavy S, Lewis P, et al. Inflammatory eye, skin, and bowel disease in spondyloarthritis: genetic, phenotypic, and environmental factors. J Rheumatol. Dec 2001;28(12):2667-73. [Medline].

  15. Colombo E, Latiano A, Palmieri O, Bossa F, Andriulli A, Annese V. Enteropathic spondyloarthropathy: a common genetic background with inflammatory bowel disease?. World J Gastroenterol. May 28 2009;15(20):2456-62. [Medline]. [Full Text].

  16. De Keyser F, Elewaut D, De Vos M, et al. Bowel inflammation and the spondyloarthropathies. Rheum Dis Clin North Am. Nov 1998;24(4):785-813, ix-x. [Medline].

  17. Ellman MH, Hanauer S, Sitrin M, Cohen R. Crohn's disease arthritis treated with infliximab: an open trial in four patients. J Clin Rheumatol. Apr 2001;7(2):67-71. [Medline].

  18. Fomberstein B, Yerra N, Pitchumoni CS. Rheumatological complications of GI disorders. Am J Gastroenterol. Jun 1996;91(6):1090-103. [Medline].

  19. Grigoryan M, Roemer FW, Mohr A, et al. Imaging in spondyloarthropathies. Curr Rheumatol Rep. Apr 2004;6(2):102-9. [Medline].

  20. Guignard S, Gossec L, Salliot C, et al. Efficacy of tumour necrosis factor blockers in reducing uveitis flares in patients with spondylarthropathy: a retrospective study. Ann Rheum Dis. Dec 2006;65(12):1631-4. [Medline].

  21. Herfarth H, Obermeier F, Andus T, Rogler G, Nikolaus S, Kuehbacher T, et al. Improvement of arthritis and arthralgia after treatment with infliximab (Remicade) in a German prospective, open-label, multicenter trial in refractory Crohn's disease. Am J Gastroenterol. Oct 2002;97(10):2688-90. [Medline].

  22. Holden W, Orchard T, Wordsworth P. Enteropathic arthritis. Rheum Dis Clin North Am. Aug 2003;29(3):513-30, viii. [Medline].

  23. Karimi O, Pena AS. Indications and challenges of probiotics, prebiotics, and synbiotics in the management of arthralgias and spondyloarthropathies in inflammatory bowel disease. J Clin Gastroenterol. Sep 2008;42 Suppl 3 Pt 1:S136-41. [Medline].

  24. Katz JP, Lichtenstein GR. Rheumatologic manifestations of gastrointestinal diseases. Gastroenterol Clin North Am. Sep 1998;27(3):533-62, v. [Medline].

  25. Kaufman I, Caspi D, Yeshurun D, Dotan I, Yaron M, Elkayam O. The effect of infliximab on extraintestinal manifestations of Crohn's disease. Rheumatol Int. Aug 2005;25(6):406-10. [Medline].

  26. Levine JS, Burakoff R. Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Hepatol (N Y). Apr 2011;7(4):235-41. [Medline].

  27. Mielants H, Veys EM. Enteropathic arthropathis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Rheumatology. 4th. Mosby Elsevier; 2008:1189-1195 / 113.

  28. Palm O, Moum B, Jahnsen J, et al. The prevalence and incidence of peripheral arthritis in patients with inflammatory bowel disease, a prospective population-based sudy (the IBSEN study). Rheumatology. 2001;40:1256-1261.

  29. Reveille JD. Epidemiology of spondyloarthritis in North America. Am J Med Sci. Apr 2011;341(4):284-6. [Medline]. [Full Text].

  30. Reveille JD, Arnett FC. Spondyloarthritis: update on pathogenesis and management. Am J Med. Jun 2005;118(6):592-603. [Medline].

  31. Szpalski M, Gunzburg R. What are the advances for surgical therapy of inflammatory diseases of the spine?. Best Pract Res Clin Rheumatol. Jan 2002;16(1):141-54. [Medline].

  32. Wollheim FA. Enteropathic arthritis: how do the joints talk with the gut?. Curr Opin Rheumatol. Jul 2001;13(4):305-9. [Medline].

  33. Wright V. Enteropathic arthritis. Cleve Clin J Med. Jan-Feb 1994;61(1):14-6; quiz 80-2. [Medline].

 
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