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Enteropathic Arthropathy

Enteropathic Arthropathy. IBD INTESTINAL BYPASS ARTHRITIS WHIPPLE'S DISEASE Celiac disease. Inflammatory bowel disease. Ulcerative colitis Crohn’s disease. Inflammatory bowel disease. Intestinal involvement Extraintestinal involvement. Extraintestinal involvement. Arthritis

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Enteropathic Arthropathy

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  1. Enteropathic Arthropathy • IBD • INTESTINAL BYPASS ARTHRITIS • WHIPPLE'S DISEASE • Celiac disease

  2. Inflammatory bowel disease • Ulcerative colitis • Crohn’s disease

  3. Inflammatory bowel disease • Intestinal involvement • Extraintestinal involvement

  4. Extraintestinal involvement • Arthritis • Aphthous stomatitis • Erythema nodosum • Anterior uveitis • Pyoderma gangrenosum

  5. Other rheumatic problems • Achilles tendinitis • Clubbing • Hypertrophic osteoarthropathy • Osteoporosis • Vasculitis • Amyloidosis

  6. Musculoskeletal • Peripheral arthritis • Axial arthritis • Both of them

  7. Peripheral Arthritis • Peripheral arthritis : 9 – 30% • More likely in patients with large-bowel disease and in those patients with complications • Male=female • Arthritis may precede symptms of GI especially in children

  8. Peripheral Arthritis • Acute arthritis • Symmetric, migratory polyarthritis affecting primarily large joints of the lower • Associated with a flare-up of the bowel disease • Occurs early • Is self-limiting • Without destruction

  9. Peripheral Arthritis • Lab test: RF – HLA-BW62 Synovial fluids have 5000 to 12,000 white blood cells

  10. Radiology • Soft tissue swelling and effusions without erosions or destruction

  11. Course • Is self-limiting (90% of cases resolve within 6 months) • Responds to successful treatment of the bowel disease

  12. Spondylitis • Frequency : 1.1 to 43% • Spondylitis often precedes IBD • M>F • The activity of spondylitis dose not correlate with activity of IBD

  13. Clinical features • Pain and stiffness in the back and/or buttocks in the morning or after rest • Stiffness and pain are often relieved by exercise • Physical examination reveals limitation of spinal flexion and reduced chest expansion • Some patients may have peripheral arthritis

  14. Lab. test • HLA-B27 : 53 to 75%

  15. Radiology • Typical findings of ankylosing spondylitis and bilateral sacroiliitis

  16. Treatment • Glucocorticoids • Anti-tumor necrosis factor • Sulfasalazine • Colectomy (for ulcerative colitis)

  17. UNDIFFERENTIATEDSpndyloarthropathy • Have some features of one or more of the spondyloarthropathies but there are not enough evidences to meet criteria for differentiated spondyloarthropathies • Are not uncommon • usually young adults

  18. UNDIFFERENTIATEDSpndyloarthropathy • Approximately half the patients with undifferentiated spondyloarthropathy are HLA-B27 positive, and thus the absence of B27 is not useful in establishing or excluding the diagnosis.

  19. Clinical presentations • inflammatory synovitis of one knee, Achilles tendinitis, and dactylitis of one digit ("sausage digit"), or sacroiliitis in the absence of other criteria for AS

  20. Course • Some cases, the patient subsequently develops IBD or psoriasis or the process eventually meets criteria for ankylosing spondylitis.

  21. juvenile-onset spondyloarthropathy • Age : 7-16 • M>f • Asymmetric, predominantly lower extremity oligoarthritis and enthesitis without extraarticular features is the typical mode of presentation

  22. juvenile-onset spondyloarthropathy • SEA syndrome (seronegative, enthesopathy, arthropathy(

  23. juvenile-onset spondyloarthropathy • Prevalence of B27:80% • Many, but not all, of these patients go on to develop typical ankylosing spondylitis in late adolescence or adulthood.

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