Enteropathic Arthritis

Excerpt

Enteropathic arthritis, a spondyloarthritis associated with inflammatory bowel disease and other gastrointestinal diseases, is an immune-driven inflammatory disease process. Joint involvement is the most frequent and impactful extraintestinal manifestation of inflammatory bowel disease. Enteropathic arthritis may predate the onset of the intestinal manifestations of inflammatory bowel disease. Spondyloarthritis is a group of inflammatory arthritides that share common characteristics and may present with axial, peripheral, or combined symptomatology.

Axial joint involvement ranges from subclinical inflammation to highly limiting symptoms, which may occur independently of inflammatory bowel activity. Peripheral joint disease may follow an oligoarticular or polyarticular pattern; symptoms may parallel or be discordant with bowel inflammation. While patients with peripheral arthritis may not develop erosive disease, untreated chronic inflammation leads to significant joint complications, including joint deformities and functional loss.

The 1998 Oxford criteria for classifying enteropathic spondyloarthritis has been used frequently in gastroenterological studies. These criteria originally classified enteropathic spondyloarthritis into 2 types but have been expanded. Type 1 enteropathic arthritis is an oligoarticular disease paralleling bowel inflammation that is commonly self-limited. Type 2 enteropathic arthritis is a chronic symmetric polyarticular disease independent of bowel activity. Type 3 enteropathic arthritis is characterized by axial and peripheral involvement. Joint disease may be further assessed through the Assessment of Spondyloarthritis International Society (ASAS) classification criteria. Characterization of joint disease is essential when choosing treatment options that address all disease domains.

The emergence of biological therapies has drastically improved the outcomes for both bowel and joint symptoms in patients with inflammatory bowel diseases. These therapies must be targeted to address specific disease domains while accounting for comorbidities. The links between arthritic and bowel inflammation continue to be elucidated, with emerging evidence of dysbiosis and decreased microbiota diversity impacting disease onset and progression.