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Enteropathic Arthropathies Workup

  • Author: Pierre Minerva, MD; Chief Editor: Herbert S Diamond, MD  more...
Updated: Dec 30, 2014

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).[5]


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.[6]


Imaging Studies


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.


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

Contributor Information and Disclosures

Pierre Minerva, MD Consulting Staff, Department of Rheumatology, Bryn Mawr Medical Specialists Association; Consulting Staff, Department of Rheumatology, Bryn Mawr Hospital, Lankenau 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 Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; 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, Phi Beta Kappa

Disclosure: Nothing to disclose.


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

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