Clinical features of the inflammatory peripheral arthritis associated with idiopathic IBD

Clinical features of the inflammatory peripheral arthritis associated with idiopathic IBD

Type I (arthritis often parallels IBD activity) occurs in 4% to 6% of patients with IBD. It affects both males and females equally. Children are affected as often as adults. The arthritis is typically acute (80%) in onset and asymmetric (80%). It usually involves fewer than five joints (i.e., oligoarticular), especially the knees or ankles. It occurs prior to (30% of cases) or early in the course of the bowel disease and is strongly associated (80%) with flares of IBD and other extraarticular manifestations (erythema nodosum, uveitis). Synovial fluid analysis reveals an inflammatory fluid with up to 50,000 white blood cells (WBC)/mm (predominantly neutrophils) and negative findings on crystal examination and cultures. There is an increased prevalence of human leukocyte antigen (HLA)-B27, HLA-B35, and HLA-DRB1*0103 in this type of arthritis. Most arthritic episodes are self-limited (80% within 3 months) and do not result in radiographic changes or deformities. 

Type 2 (arthritis independent of IBD activity) is less common, occurring in 3% to 4% of IBD cases. The arthritis tends to be symmetric (80%), polyarticular (metacarpophalangeal joints, knees, and ankles more than other joints), runs a course independent of the activity of IBD, and does not coincide with extraarticular manifestations (except uveitis). Active synovitis persists for months (90% of cases) and episodes of exacerbations and remissions may continue for years. Because of its chronicity, this type of arthritis can cause erosions and deformities. There is an association of this arthritis with HLA-B44 but not with HLA-B27 .

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