1 / 29

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

jgracia
Download Presentation

Enteropathic Arthropathy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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.

More Related