What is bowel associated dermatosis arthritis syndrome?
In the past, this syndrome occurred in 20% of patients who underwent intestinal bypass surgery for morbid obesity, but it can also occur in patients with IBD, diverticular disease, other bowel surgeries, and as a rare consequence of bacterial overgrowth in patients with poor intestinal peristalsis (systemic sclerosis, colorectal surgery). Affected patients develop a flu-like syndrome consisting of fevers, malaise, arthritis, myalgia, and rashes. The arthritis is nonerosive, inflammatory, oligoarticular, and frequently migratory, affecting both upper and lower extremity small and large joints. The rash is maculopapular or vesiculopustular usually on the upper extremities and trunk. The pathogenesis involves bacterial overgrowth in a blind loop of bowel resulting in antigenic stimulation causing immune complex formation (frequently cryoprecipitates containing bacterial antigens, secretory IgA, and complement) in the serum that deposits in the joints and skin. Treatment includes NSAIDs, corticosteroids, and oral antibiotics, which usually improve symptoms. Only surgical reanastomosis of the blind loop can result in complete elimination of symptoms.