Enteropathic arthropathy: Difference between revisions
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==Classification== | ==Classification== | ||
*Axial | *Axial | ||
** | **[[Sacroiliitis|Sacroilitis]] | ||
**Spondylitis | **[[Spondylitis]] | ||
*Peripheral arthritis | *Peripheral arthritis | ||
| Line 27: | Line 27: | ||
==Risk factors== | ==Risk factors== | ||
*HLA-B27 positive people | *[[HLA-B27]] positive people | ||
*Active inflammatory bowel disease | *Active [[inflammatory bowel disease]] (IBD) | ||
*Positive family history | *Positive family history | ||
*Tobacco smoking | *Tobacco smoking | ||
| Line 39: | Line 39: | ||
==Differential diagnosis== | ==Differential diagnosis== | ||
The Differential diagnosis of | The Differential diagnosis of enteropathic arthritis are as follows: | ||
*Reactive arthritis | *[[Reactive arthritis]] | ||
*Psoriatic arthritis | *[[Psoriatic arthritis]] | ||
* | *[[Ankylosing spondylitis]] | ||
*Rheumatoid arthritis | *[[Rheumatoid arthritis]] | ||
*Lyme disease | *[[Lyme disease]] | ||
*Behcet's disease | *[[Behçet's disease|Behcet's disease]] | ||
*Gout | *[[Gout]] | ||
*Sarcoidosis | *[[Sarcoidosis]] | ||
*Septic arthritis | *[[Septic arthritis]] | ||
==Signs and Symptoms== | ==Signs and Symptoms== | ||
| Line 107: | Line 107: | ||
*[[Enthesitis]] | *[[Enthesitis]] | ||
*[[Dactilitis]] | *[[Dactilitis]] | ||
==Laboratory Findings== | |||
The laboratory tests for the Enteropathic arthritis are as follows:<ref>{{cite journal | last = Kaila | first = B. | coauthors = K. Orr and C. N. Bernstein | year = 2005 | month = December | title = The anti-Saccharomyces cerevisiae antibody assay in a province-wide practice: accurate in identifying cases of Crohn's disease and predicting inflammatory disease | journal = The Canadian Journal of Gastroenterology | volume = 19 | issue = 12 | pages = 717-21 | id = PMID 16341311 | url =http://www.pulsus.com/Gastro/19_12/kail_ed.htm | accessdate = 2006-07-02 }}</ref><ref>{{cite journal | last = Israeli | first = E. | coauthors = I. Grotto, B. Gilburd, R. D. Balicer, E. Goldin, A. Wiik and Y. Shoenfeld | year = 2005 | month = September | title = Anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies as predictors of inflammatory bowel disease | journal = Gut | volume = 54 | issue = 9 | pages = 1232-6 | doi =10.1136/gut.2004.060228 | id = PMID 16099791 }}</ref> | |||
{| class="wikitable" | |||
!Laboratory tests | |||
!Findings | |||
|- | |||
|CBC | |||
| | |||
* [[Anemia]] | |||
* [[Leucocytosis]] | |||
* [[Thrombocytosis]] | |||
|- | |||
|Iron studies | |||
| | |||
* + [[Iron deficiency anemia]] | |||
|- | |||
|Serum Vit B12 | |||
| | |||
* Normal or low | |||
|- | |||
|[null Serum folate] | |||
| | |||
* Normal or low | |||
|- | |||
|CMP | |||
| | |||
* [[Hypoalbuminemia]] | |||
* [[Hypocalcemia]] | |||
|- | |||
|CRP and ESR | |||
| | |||
* Elevated | |||
|- | |||
|Stool testing | |||
| | |||
* Negative for infectious elements | |||
|- | |||
|Yersinia serology | |||
| | |||
* Negative | |||
|} | |||
==Diagnostic test of choice== | |||
==Medical Therapy== | |||
'''Non-Pharmacological therapy''' | |||
*[[Physiotherapy]] including spinal mobility exercises | |||
*Diet specific for IBD patients | |||
*Referral to [[Ophthalmologist]] for the [[Anterior uveitis|anterior uveitis.]] | |||
'''Pharmacological therapy''' | |||
*[[Non-steroidal anti-inflammatory drug|Non-steroidal anti-inflammatory drug (NSAIDS]]) | |||
*[[Corticosteroids]] | |||
**[[Intraarticular|Intraarticular corticosteroids]] | |||
**Systemic corticosteroids | |||
*[[Sulfasalazine]] | |||
*[[Methotrexate]] | |||
*[[Azathioprine]] | |||
*[[Pamidronate]] | |||
*[[Cyclosporine|Ciclosporin]] | |||
*[[Tumor necrosis factors|Tumour necrosis factor (TNF) antagonists]] | |||
Latest revision as of 21:47, 19 April 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]
Overview
Enteropathic arthropathy or Enteropathic arthritis refers to acute or subacute arthritis in association with or as a reaction to an enteric (usually colonic) inflammatory condition.
Classification
- Axial
- Peripheral arthritis
- Type I Arthropathy
- Less than five joints involved
- Acute
- Less than 10 weeks
- Asymmetrical
- Shoulder, hips and knee joints are involved
- Type II Arthropathy
- More than five joints involved
- Chronic
- Months to years
- Symmetrical
- Small joints are involved.
Pathophysiology
Risk factors
- HLA-B27 positive people
- Active inflammatory bowel disease (IBD)
- Positive family history
- Tobacco smoking
Causes
- Reactive arthritis (Reactive to enteric infection)
- Spondyloarthropathies associated with inflammatory bowel disease (Crohn disease and ulcerative colitis)
- Malabsorption related: Intestinal bypass (jejunoileal), Celiac disease, Whipple disease
- Collagenous colitis
Differential diagnosis
The Differential diagnosis of enteropathic arthritis are as follows:
- Reactive arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- Rheumatoid arthritis
- Lyme disease
- Behcet's disease
- Gout
- Sarcoidosis
- Septic arthritis
Signs and Symptoms
- Sacroiliitis and Spondylitis- Low back pain exacerbated on sitting and standing for a prolonged period and relieved by activity.
- Enthesitis- Inflammation of the tendon at the insertion of the bone such as tibial tuberosity, achilles tendon at the heel.
- Dactilitis- Inflammation of the digit.
- Type I Arthropathy
- Less than five joints involved
- Acute
- Less than 10 weeks
- Asymmetrical
- Shoulder, hips and knee joints are involved
- Type II Arthropathy
- More than five joints involved
- Chronic
- Months to years
- Symmetrical
- Small joints are involved.
- Extra Articular
- Aphthous ulcers
- Uveitis
- Fever
- Weight loss
- Abdominal pain
- Diarrhea
- Pyoderma gangrenosum
- Erythema nodosum
Physical Examination
The physical examination findings of a patient with Enteropathic arthropathy include:[1][2][3][4]
General Appearance
Vitals
HEENT
Cardiovascular System
- Normal S1 and S2 sounds
- Tachycardia
Gastrointestinal System
- Abdominal tenderness in the right lower quadrant
- Abdominal distension
Skin
Musculoskeletal System
- Inflammation of the joints.
- Enthesitis
- Dactilitis
Laboratory Findings
The laboratory tests for the Enteropathic arthritis are as follows:[5][6]
| Laboratory tests | Findings |
|---|---|
| CBC | |
| Iron studies | |
| Serum Vit B12 |
|
| [null Serum folate] |
|
| CMP | |
| CRP and ESR |
|
| Stool testing |
|
| Yersinia serology |
|
Diagnostic test of choice
Medical Therapy
Non-Pharmacological therapy
- Physiotherapy including spinal mobility exercises
- Diet specific for IBD patients
- Referral to Ophthalmologist for the anterior uveitis.
Pharmacological therapy
- Non-steroidal anti-inflammatory drug (NSAIDS)
- Corticosteroids
- Intraarticular corticosteroids
- Systemic corticosteroids
- Sulfasalazine
- Methotrexate
- Azathioprine
- Pamidronate
- Ciclosporin
- Tumour necrosis factor (TNF) antagonists
References
- ↑ Ha F, Khalil H (2015). "Crohn's disease: a clinical update". Therap Adv Gastroenterol. 8 (6): 352–9. doi:10.1177/1756283X15592585. PMC 4622286. PMID 26557891.
- ↑ Wilkins T, Jarvis K, Patel J (2011). "Diagnosis and management of Crohn's disease". Am Fam Physician. 84 (12): 1365–75. PMID 22230271.
- ↑ Donnellan CF, Yann LH, Lal S (2013). "Nutritional management of Crohn's disease". Therap Adv Gastroenterol. 6 (3): 231–42. doi:10.1177/1756283X13477715. PMC 3625021. PMID 23634187.
- ↑ Baumgart DC (2009). "The diagnosis and treatment of Crohn's disease and ulcerative colitis". Dtsch Arztebl Int. 106 (8): 123–33. doi:10.3238/arztebl.2009.0123. PMC 2695363. PMID 19568370.
- ↑ Kaila, B. (2005). "The anti-Saccharomyces cerevisiae antibody assay in a province-wide practice: accurate in identifying cases of Crohn's disease and predicting inflammatory disease". The Canadian Journal of Gastroenterology. 19 (12): 717–21. PMID 16341311. Retrieved 2006-07-02. Unknown parameter
|month=ignored (help); Unknown parameter|coauthors=ignored (help) - ↑ Israeli, E. (2005). "Anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies as predictors of inflammatory bowel disease". Gut. 54 (9): 1232–6. doi:10.1136/gut.2004.060228. PMID 16099791. Unknown parameter
|coauthors=ignored (help); Unknown parameter|month=ignored (help)