ENTEROPATHIC ARTHRITIS
 
PEDBASE.org - The Pediatric Database - Detailed information of ENTEROPATHIC ARTHRITIS

 

ENTEROPATHIC ARTHRITIS

 

DEFINITION:

A seronegative spondyloarthropathy involving entheses with joint and systemic (ophthalmologic, gastrointestinal) manifestations.

EPIDEMIOLOGY:

  • incidence: 13-17% with inflammatory bowel disease have Enteropathic Arthritis
  • age of onset:
    • ?
  • risk factors:
    • HLA-B27
    • gastrointestinal infections: yersinia, shigella, salmonella, campylobactr
    • Inflammatory Bowel Disease (IBD): Ulcerative Colitis > Crohn's
  • target joints:
    • major: peripheral - large lower extremities
    • minor: axial - sacroiliitis

PATHOGENESIS:

1. Background

  • those people with HLA-B27 who also happen to get an IBD or a bacillary dysentery, are at risk for developing an enteropathic arthritis

CLINICAL FEATURES:

1. Arthritis

1. Axial Joints

  • 1. Sacroiliitis
    • asymmetric with low back, buttock, & thigh pain and stiffness
    • more likely to persist and progress
    • less responsive to the gastrointestinal (GI) course
    • less commonly affected than peripheral joints

    • 2. Peripheral Joints

  • 1. Lower Large Joints (Polyarthritis)
    • knees & ankles most often affected
    • most patients have 4 or more joints affected
    • arthritis lasts 4-6 weeks
    • usually have 2 or more episodes of arthritis
    • functional or joint damage is unusual
    • more responsive to the gastrointestinal course
    • more commonly affected than axial joints

    • 2. Entheses

    • Enthesitis

    3. Systemic Manifestations

  • 1. Ophthalmologic
    • iritis
  • 2. Gastrointestinal
    • IBD, bacillary dysentery
  • 3. Cutaneous
    • mucocutaneous lesions

    • INVESTIGATIONS:

    1. Serum

    • seronegative - RF and ANA
    • HLA-B27 positive

    2. Imaging Studies

  • 1. Skeletal X-Rays
    • spine, SI joint
    • peripheral joints
    • entheses

    • MANAGEMENT:

    1. Supportive

    • team approach with long-term follow-up
    • treat underlying cause - Inflammatory Bowel Disease or bacillary dysentery
    • physiotherapy to increase range of motion of peripheral joints and back
    • enthesitis:
      • custom-made insoles
      • ultrasound or transcutaneous nerve stimulation

    2. Medications

    • anti-inflammatory drugs:
      • ASA
      • NSAID

     

     

     

    Pediatric Database - ENTEROPATHIC ARTHRITIS

     

    Pediatric Organization - Pedbase [at] Gmail.com

     
    1994 -2007 Pedbase.org 

    Powered by Database of Pediatrics- ENTEROPATHIC ARTHRITIS