INFO - Inflammatory bowel disease and joint problems

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American Family Physician

February 1989

An excerpt from " Inflammatory bowel diseases: part II. Extraintestinal

involvement and management " :

JOINT PROBLEMS

Arthritis is the most common extraintestinal condition associated with

Crohn's disease and ulcerative colitis, although most patients do not

develop arthritis. Many investigators have attributed the arthritis to an

immunologic process that may accompany the intestinal disease, but

convincing evidence for this theory is still lacking.[1]

Three types of arthritis may develop: rheumatoid-like arthritis, ankylosing

spondylitis and peripheral large joint arthritis. The first form mimics

rheumatoid arthritis in many ways. It usually involves the wrists and

fingers and may improve or worsen without regard to the course of the bowel

disease. Some patients with this form of arthritis have positive tests for

rheumatoid factor.

Ankylosing spondylitis is painful and may cause stiffening of the spine,

hips, neck, jaw and rib cage. As with rheumatoid-like involvement, its

course is independent of the underlying bowel disease. The condition may

improve or worsen and, on occasion, may even develop after the diseased

bowel has been removed or the colitis has improved. Ankylosing spondylitis

is more common in males than females and usually has an onset before age 30.

Large joint arthritis usually affects the knees, ankles, hips and,

occasionally, the elbows and shoulders. The small joints of the hands and

feet and the spine are usually not involved. Unlike the other types of

arthritis, this form often worsens and improves as the bowel disease worsens

and improves. It sometimes, however, worsens before the bowel disease

activates. This kind of arthritis does not leave permanent joint

deformities.

The joint arthritis usually develops in single large joints, but migratory

polyarthritis may occur. Synovitis with fluid accumulation is a common

characteristic of large joint arthritis. Even more common than synovitis are

the muscle aches that accompany any exacerbation of Crohn's disease or

ulcerative colitis. Both the muscle aches and the peripheral arthritis often

respond to treatment of the underlying bowel disease.

A central arthritis (for example, sacroiliitis) has been described in 4 to

15 percent of patients with Crohn's disease or ulcerative colitis.[2] It may

develop independently of the bowel disease and may even occur after

colectomy. Thus, improvement in the bowel disease does not correlate with

improvement in the central arthritis. There appears to be a genetic

predisposition to the development of central arthritis and ankylosing

spondylitis in patients with Crohn's disease or ulcerative colitis, as

revealed by an increased incidence of HLA-B27 antigen in these patients.

Both conditions are usually chronic, progressive and deforming.

http://www.findarticles.com/p/articles/mi_m3225/is_n2_v39/ai_7553283

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