Enteropathic arthropathy

# 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
Sacroilitis
Spondylitis
- Sacroilitis
- Spondylitis
- Peripheral arthritis
- Type I Arthropathy
Less than five joints involved
Acute
Less than 10 weeks
Asymmetrical
Shoulder, hips and knee joints are involved
- 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.
- 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
- 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.
- 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
- 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:

## General Appearance
- Weakness
- Fatigue

## Vitals
- Fever
- Tachycardia

## HEENT
- Aphthous ulcers
- Episcleritis and uveitis

## Cardiovascular System
- Normal S1 and S2 sounds
- Tachycardia

## Gastrointestinal System
- Abdominal tenderness in the right lower quadrant
- Abdominal distension

## Skin
- Erythema nodosum
- Pyoderma gangrenosum

## Musculoskeletal System
- Inflammation of the joints.
- Enthesitis
- Dactilitis

# Laboratory Findings
The laboratory tests for the Enteropathic arthritis are as follows:

# 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
- Intraarticular corticosteroids
- Systemic corticosteroids
- Sulfasalazine
- Methotrexate
- Azathioprine
- Pamidronate
- Ciclosporin
- Tumour necrosis factor (TNF) antagonists