Inflammatory arthritis associated with inflammatory bowel disease; may present before, during or after a diagnosis of IBD

Aetiology

• 10-20% of IBD sufferers will experience spine or joint problems
• 20% of patients with Crohn's will have sacroiliitis
• Worsening of symptoms during flare-ups of IBD

Clinical features

Symptoms

• Patients present with arthritis in several joints, especially knees, ankles, elbows, and wrists, sometimes spine, hips, or shoulders
• GI - loose, watery stool with mucous and blood
• Weight loss

Signs

• Low grade fever
• Uveitis
• Pyoderma gangrenosum
• Enthesitis - archilles tendontitis, plantar fasciitis, lateral epicondylitis
• Aphthous ulcers

Investigations

• Bloods: raised inflammatory markers, rheumatoid factor and ANA negative, pANCA seen in 55-70% of patients with ulcerative collitis, positive HLA B27 can support diagnosis
• Upper and lower GI endoscopy with biopsy: showing ulceration/colitis
• Joint aspirate: to rule out septic arthritis and crystal arthropathies (no organisms or crystals will be seen)