Enteric arthritis is a seronegative spondyloarthopathy associated with gastrointestinal disease. Joint symptoms may precede bowel disease, occur simultaneously, or develop years later.
- Risk factors
- HLA-B27
- IL-23 polymorphisms
- ERAP-1/ERAP-2
- Associated conditions
- Inflammatory bowel disease
- Gastrointestinal bypass
- Coeliac disease
- Whipple’s disease
- Pathophysiology
- Gut dysbiosis and increased intestinal permeability → translocation of microbial antigens → immune activation → joint inflammation
- Signs and symptoms
- Lower back pain (axial disease)
- Joint pain
- Mono or polyarticular types
- Morning stiffenss
- Worse with rest
- Improves with activity
- Reduced spinal flexion
- Reduced chest expansion
- Differentials
- Fibromyalgia
- Irritable bowel syndrome
- Reactive arthritis
- Behcet disease
- Brucellosis
- Whipple disease
- Investigations
- ESR and CRP raised
- Rheumatoid factor
- Negative
- X-ray of the sacroiliac joint
- Erosions
- Sclerosis
- Syndesmophytes
- MRI of the sacroiliac joint
- Bone marrow oedema
- Osteitis
- Early sacroilitis
- Treatment
- Arthropathy improves with treatment of bowel symptoms
- DMARDs for resistant cases
- Biological therapy may be considered in advanced disease
- Physiotherapy
