Inflammatory Bowel Disease-Associated Arthritis
Type I disease Type II disease Type III disease IBD-associated arthritis occurs in patients with Crohn’s disease or ulcerative colitis. [41] Enteropathic arthritis can also occur in other gastrointestinal problems, namely, coeliac disease, Whipple’s disease and intestinal bypass surgery. Patients with IBD-associated arthritis share many of the clinical features of the other SpAs. Of note, degener
IBD-associated arthritis occurs in patients with Crohn’s disease or ulcerative colitis.[41] Enteropathic arthritis can also occur in other gastrointestinal problems, namely, coeliac disease, Whipple’s disease and intestinal bypass surgery. Patients with IBD-associated arthritis share many of the clinical features of the other SpAs. Of note, degenerative joint and spine disease, fibromyalgia syndrome, osteoporosis and gout are common causes of musculoskeletal symptoms in patients with IBD. This group of disorders is best managed by a multidisciplinary team, which includes a gastroenterologist, a rheumatologist and an ophthalmologist if necessary.
Type I disease
Mono- or oligoarticular, and generally self-limiting. Arthritis may occur early in the disease course and may be associated with erythema nodosum and other extra-articular manifestations. Flares in arthritis coincide with a worsening of the IBD, and treatment of the IBD often results in a resolution of arthritis.
Symptomatic treatment with bed rest and intra-articular corticosteroid injections. NSAIDs may be used with caution after discussion with the gastroenterologist.[42] If persistent, SSZ or MTX may be considered.[43,44] Poor responders may require monoclonal TNFi: infliximab, golimumab, or adalimumab.[45] Alternatively, IL-12/23 inhibitor (ustekinumab) can be used, noting the different drug dosing regimens. The soluble receptor TNFi (etanercept) and IL-17i are not recommended in IBD.
Type II disease
Polyarticular and erosive, affecting large and small joints and has an independent course to the IBD. This arthritis is strongly associated with uveitis.
Treatment with SSZ is recommended as first-line therapy. With an inadequate response, consider cyclosporine, or LEF.[46] If there is a poor response, monoclonal TNFi including infliximab, golimumab, or adalimumab may be used.[45] The soluble receptor TNFi (etanercept) and IL-17i are not recommended in IBD.
Type III disease
Peripheral and axial joints. The spondylitis generally precedes the onset of IBD and runs an independent course.
Treatment includes NSAIDs, SSZ, MTX, LEF and TNFi. Isolated sacroiliitis is usually non-progressive and responds to NSAIDs. Failure to respond to NSAIDs is an indication for b/tsDMARD therapy.[47]
Benitha, R., Maharaj, A. B., Makan, K., Potts, J., Lai, A., Carter, R., van Dam, M., & Hodkinson, B. (2024). South African Rheumatism and Arthritis Association 2024 guidelines for the management of peripheral spondyloarthritis. South African Medical Journal, 114(10), e2669.