What is Enteropathic Arthritis?
Enteropathic arthritis (EnA) is a form of chronic, inflammatory arthritis that occurs in people who have inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis.
Arthritis is a chronic (long-term) condition involving pain and swelling in your joints. Inflammatory bowel disease is a chronic inflammation of a part or all of your digestive tract. People with enteropathic arthritis have both swelling and chronic pain in their joints and inflammation in their digestive tract.
EnA is a type of spondyloarthritis - a group of related inflammatory diseases that often involve both the joints and the spine and internal organs, such as the intestines.
The two main forms of enteropathic arthritis are peripheral and axial.
- Peripheral arthritis: Affects arms and legs, especially knees, ankles, and wrists.
- Axial arthritis: Affects the spine and sacroiliac joints (lower back and pelvis).
- Joint pain may flare up when the bowel disease is active.
Causes of Enteropathic Arthritis
Enteropathic arthritis is primarily caused by the underlying inflammation seen in IBD, such as Crohn’s disease and ulcerative colitis. Although the exact mechanism is not fully understood, it is believed that chronic intestinal inflammation can trigger an abnormal immune response that extends to the joints. Genetic factors also play a role, with a strong association seen in individuals carrying the HLA-B27 gene, especially in cases involving spinal inflammation. Additionally, an imbalance in the gut microbiome and immune system dysregulation may contribute to joint inflammation. Environmental factors like infections or stress may act as triggers in genetically susceptible individuals.
Signs and Symptoms of Enteropathic Arthritis
Signs and symptoms associated with enteropathic arthritis include:
- Pain, swelling, and stiffness in the joints
- Lower back pain (if the spine is affected)
- Morning stiffness (especially if axial)
- Fatigue
- Episodic flares
- Gastrointestinal symptoms like abdominal pain, diarrhea, and weight loss (linked to IBD)
Diagnosis of Enteropathic Arthritis
The diagnosis of enteropathic arthritis is based on a combination of clinical history, physical examination, and supportive tests. It typically begins with identifying symptoms of joint pain, stiffness, and swelling in a patient with known inflammatory bowel disease (Crohn’s disease or ulcerative colitis). A physical exam may reveal joint tenderness or limited range of motion. Blood tests such as ESR and CRP can indicate inflammation, and HLA-B27 testing may be done, especially in cases with spinal involvement. Imaging studies like X-rays or MRI help detect inflammation or structural changes in the joints or spine. Since no single test confirms the condition, diagnosis relies on correlating musculoskeletal symptoms with IBD and ruling out other forms of arthritis.
Treatment for Enteropathic Arthritis
The treatment for enteropathic arthritis aims to manage both joint inflammation and the underlying inflammatory bowel disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve joint pain and stiffness, but must be used cautiously, as they may aggravate IBD symptoms. Corticosteroids are often prescribed for short-term control of flare-ups, both in the joints and the gut. For patients with peripheral arthritis, disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine or methotrexate may be effective. Biologic therapies, particularly tumor necrosis factor (TNF) inhibitors like infliximab and adalimumab, are highly effective for treating both joint and bowel inflammation and are often the preferred option in moderate to severe cases. Physical therapy is an important supportive treatment to maintain joint mobility and function. Treatment plans are individualized based on the severity and type of joint involvement - whether peripheral or axial - as well as the activity level of the bowel disease.
