Enteropathic Arthritis

Excerpt

Enteropathic arthritis refers to immune-driven rheumatologic conditions linked to gastrointestinal pathology, typically denoting the inflammatory spondyloarthropathies associated with inflammatory bowel disease (IBD) and reactive arthritis triggered by bacterial and parasitic infections. Psoriatic arthritis, ankylosing spondylitis, and undifferentiated spondyloarthropathy are other inflammatory spondyloarthropathies.

Joint involvement is a common extraintestinal manifestation of IBD, which may precede the onset of intestinal manifestations. Spondyloarthritis manifests with axial involvement of the spine and sacroiliac joints, peripheral involvement, or a combination of both. Patients with other gastrointestinal illnesses such as celiac disease, Whipple disease, and collagenous colitis may also experience arthritis.

Axial joint involvement in enteropathic arthropathy varies from subclinical inflammation observed on imaging to severe symptoms with functional limitations, which may progress independently of the underlying IBD activity. Peripheral joint disease exhibits an oligoarticular or polyarticular pattern, with symptoms more often correlating with bowel inflammation. The symptoms and findings associated with peripheral spondyloarthritis are predominantly or entirely peripheral rather than axial. Arthritis, which is asymmetric or predominantly of the lower limbs, enthesitis, and dactylitis are all common features of peripheral spondyloarthritis.

The Oxford criteria classifies enteropathic spondyloarthritis into 3 types. Type 1 describes oligoarticular disease correlating with bowel inflammation, type 2 describes chronic symmetric polyarticular disease independent of IBD activity, and type 3 presents as axial and sometimes peripheral involvement whose progression does not correlate with IBD activity. Healthcare professionals seldom utilize this classification and designate all subtypes as peripheral spondyloarthritis.

The emergence of biological therapies has significantly improved outcomes for both IBD and associated arthropathies. The interconnection between arthritis and bowel inflammation is continually unfolding, with emerging evidence of dysbiosis and decreased microbiota diversity impacting disease onset and progression. Healthcare professionals can further classify axial disease using the Assessment of Spondyloarthritis International Society classification criteria. Assessing joint disease is crucial for selecting treatments that cover all aspects of the condition. When choosing therapies, clinicians should also consider related manifestations such as uveitis, psoriasis, and pyoderma gangrenosum. This method guarantees comprehensive coverage, effectively addressing all relevant disease domains.