Enteropathic Arthritis

Enteropathic arthritis involves the peripheral joints, usually in the lower extremities such as the knees or ankles. It commonly involves only a few or a limited number of joints and may closely follow the bowel condition. This occurs in approximately 11 percent of patients with ulcerative colitis and 21 percent of those with Crohn's disease. The synovitis is generally self-limited and non-deforming.

Ankylosing spondylitis is an inflammatory arthropathy of the spine. It occurs in about 7 percent of patients with inflammatory bowel disease. Minimally it involves the sacroiliac joints of the pelvis causing low back or "hip" pain. In some individuals, it may involve the lumbar spine, upper back, and neck. This form seems to follow a course independent of the activity of the bowel disease.

Reactive arthritis is an acute inflammatory arthritis that follows bacillary (infectious) dysentery. It occurs following a bacterial infection of the small or large colon, but it is not a direct infection of joints. Something occurs in the process of the body protecting itself at the intestine that results in a more distant reaction of inflammation in the peripheral joints. This type of arthritis can linger for weeks or months and then subside. It can also become a recurring type of arthritis called Reiter's syndrome. A fascinating aspect of reactive arthritis is that a cause that "triggers" the process leading to arthritis can be identified.

Bowel bypass arthritis offers similar clues. Intestinal bypass was a technique to control obesity by surgically excluding a section of the small bowel and then connecting the proximal and distal portions of the intestines. The "excluded" portion of the intestine was bypassed by food material but remained in the abdomen. Among several frequent complications, patients developed an enteropathic type of arthritis. It was observed that in patients in which the excluded bowel was surgically reconnected to the intestine, the arthritis resolved.