Can treatment alleviate the symptoms of inflammatory peripheral arthritis or spinal arthritis in IBD patients? Alleviation of Arthritic Symptoms in Inflammatory Bowel Disease Peripheral Arthritis Sacroiliitis/Spondylitis NSAIDs * Yes Yes Intra-articular corticosteroids Yes Yes (sacroiliitis) Sulfasalazine Yes No Immunosuppressives (MTX, 6-MP) Yes No Anti-TNFα Yes Yes Bowel resection UC Yes No CD No No CD, Crohn’s disease; FDA, Food …
What other rheumatic problems occur with increased frequency in IBD patients? Achilles tendon and plantar fascia enthesitis Clubbing of fingernails (5%, mostly CD) Hypertrophic osteoarthropathy (periostitis) Psoas abscess or septic hip from fistula formation (CD) Osteoporosis secondary to medications (i.e., prednisone) Granulomatous lesions of bone and joints (CD) Vasculitis (< 5%) Amyloidosis
Typical radiographic features of inflammatory sacroiliitis and spondylitis in IBD patients. The radiographic abnormalities in IBD patients with inflammatory spinal arthritis are similar to those seen in ankylosing spondylitis. Patients with early inflammatory sacroiliitis frequently have normal plain radiographs. In these patients, magnetic resonance imaging of the sacroiliac joints demonstrates inflammation and edema. Over several …
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What serologic abnormalities are seen in patients with IBD? Erythrocyte sedimentation rate (ESR) and C-reactive protein are elevated, whereas rheumatoid factor and antinuclear antibody are negative. Perinuclear antineutrophil cytoplasmic antibody is seen in more than 55% to 70% of UC patients and fewer than 20% of colon-predominant CD patients. It is usually directed against lactoferrin …
What HLA occurs more commonly than expected in patients with inflammatory spinal arthritis associated with IBD? HLA-B27 is found in 55% of CD patients and 70% of UC patients with inflammatory sacroiliitis or spondylitis. This contrasts with an 8% frequency of HLA-B27 in a normal, healthy, white population. Thus a patient with IBD who possesses the HLA-B27 gene has 7 …
Does the activity of inflammatory spinal arthritis correlate with the activity of the IBD? No. The onset of sacroiliitis or spondylitis can precede onset of IBD by years, occur concurrently, or follow onset by years. Furthermore, the course of the spinal arthritis is completely independent of the course of IBD.
Which points in the history and physical examination are helpful in separating inflammatory spinal arthritis from mechanical low back pain in an IBD patient? On the basis of history and physical examination, 90% of patients with inflammatory spinal arthritis can be differentiated from patients with mechanical low back pain. Clinical Differentiation of Inflammatory Spinal Arthritis …
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