19th January 2024

Diagnosis 

There is no gold standard criterion for the diagnosis of enteric arthritis; however, patients with a history of IBD presenting with inflammatory joint pain or synovitis are considered to have spondyloarthropathy unless proven otherwise. Investigations may be carried out to rule out other similarly presenting diagnoses.

Investigations

Blood tests

• FBC – to detect anaemia due to chronic disease or deficiency of iron, B12 or folate, or leucocytosis seen in patients with IBD
• ESR and CRP – usually elevated
• Rheumatoid factor and anti-CCP – to rule out rheumatoid arthritis

Imaging

• X-ray of affected joints – similar radiological findings to other spondyloarthropathies. Sacroiliitis tends to be asymmetrical.

Other

• Stool microscopy and culture – to investigate aetiology of undetermined bowel disease
• Sigmoidoscopy/colonoscopy/upper GI endoscopy/small bowel imaging – dependent on suspected underlying gastrointestinal disorder
• Synovial fluid aspiration – to rule out septic joint or crystal arthritis