19th January 2024

Presentation 

Joint symptoms

Peripheral arthritis can occur before, simultaneously, or after the diagnosis of IBD is established. The most common pattern of peripheral disease is that of an asymmetric mono- or oligoarthritis, affecting mostly the large joints of the lower limbs. Patients present with typical inflammatory joint pain, prolonged morning stiffness and improvement of symptoms with activity. It tends to run an episodic and recurrent course, with occasional spontaneous improvement in symptoms within 6 months; however, a minority of patients can progress to chronic disease. Exacerbations of arthritic symptoms tend to correlate closely with extent and severity of intestinal involvement in IBD, and to the presence of extra-intestinal manifestations. Enthesitis can occur, particularly in the Achilles tendon or plantar fascia.

Extra-articular manifestations of IBD

• Intestinal: abdominal pain, diarrhoea, bloody stools
• Dermatological: erythema nodosum and pyoderma gangrenosum
• Mucous membranes: painful recurrent aphthous ulcers
• Ocular: anterior uveitis
• Systemic features: fever, malaise, fatigue, weight loss

Arthritis in other gastrointestinal disorders

• Intestinal bypass surgery tends to present as polyarthritis with an associated dermatitis due to bacterial overgrowth and pathological immune complex deposition in the bypassed section of bowel.
• Whipple’s disease: mostly occurs in middle-aged men and presents as a migratory polyarthritis
• Coeliac disease: arthritis is a rare manifestation of coeliac disease but can present as a symmetrical arthritis of the lumbar spine, hips, knees, and shoulders. There is a resolution in symptoms following a gluten-free diet.