19th January 2024

Background

Definition

Enteric or enteropathic arthritis is a term used to describe patterns of inflammatory arthritis associated with gastrointestinal diseases such as inflammatory bowel disease (IBD – Crohn’s disease and ulcerative colitis), coeliac disease, Whipple’s disease and post-intestinal bypass surgery. It is a part of the spondyloarthritides, therefore, primarily affects entheses, small and large joints and the axial skeleton.

Epidemiology

IBD-associated joint disease can either affect the axial skeleton, which is more common in men, or peripheral joints primarily in the lower limbs, which is more common in women. Peripheral arthritis is the most frequent extra-intestinal manifestation of IBD, with a prevalence of between 17% and 20%, and occurs more commonly in Crohn’s disease than in ulcerative colitis.

Causes and risk factors

HLA B27 positivity is a known association of enteric arthritis affecting the axial skeleton, but not the peripheral joints. Risk factors for the development of arthritis in patients with IBD include smoking, active bowel disease, family history, and the presence of other extra-intestinal manifestations, particularly skin disease.