Enteropathic Arthropathies Workup

Updated: Feb 16, 2021
  • Author: Pierre Minerva, MD; Chief Editor: Herbert S Diamond, MD  more...
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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). [9]


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. [10]


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. [11]


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.