Empiric therapy pending results of studies may include antibiotics if single joint disease mimics septic arthritis. Most attacks are self-limited over weeks and occasionally months but may be annoyingly recurrent with asymptomatic intervals. Peripheral arthropathy of IBD is rarely chronic. HLA-B27 is not diagnostic since it can occur with arthropathy in sexually transmitted infectious diseases and, more intriguingly, with the arthritis of enteric infectious disease, e.g., Yersinia, Shigella dysenteriae, S. flexneri, Salmonella enteritidis, S. typhimurium, and Campylobacter jejunii. Clinical clues are those of low back pain with limited motion or stiffness that curiously improves with motion whereas classic mechanical back pain worsens with the day s activity.
Physical therapy is very helpful.
Steroids should be avoided if possible. Other bone phenomena seen with steroids include periostitis, which is painful new bone formation that favors the long bones of the legs, and painless clubbing or hypertrophic osteoarthropathy especially with Crohn s of the small and large bowel. Return to Top Eye Manifestations Blurred vision, photophobia, headache or painful red eye may herald the diagnosis of iritis or episcleritis coexistent with active IBD, usually colonic disease. These manifestations occur commonly with joint, mouth, and skin findings. Many other eye manifestations can occur with IBD, but rarely include such serious problems such as optic neuritis, myositis with proptosis, papillopathy, chiasmal disease or orbital neuropathy.