Enteropathic Arthritis

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Enteropathic Arthritis is a form of chronic, inflammatory arthritis associated with the occurrence of an inflammatory bowel disease, the two best-known types of which are ulcerative colitis and Crohn's disease. About one in five people with Crohn's or ulcerative colitis will develop enteropathic arthritis.

The most common areas affected are inflammation of the limb joints, as well as the abdominal pain and possibly bloody diarrhea associated with the IBD component of the disease. In some cases, the entire spine can become involved as well.

The symptoms can basically be divided in two groups:

1. The symptoms of inflammatory bowel disease
2. The arthritic symptoms in the joints and possibly elsewhere in the body.

. . . IBD Symptoms
Ulcerative colitis and Crohn's disease are the two types of IBD most commonly associated with enteropathic arthritis in spondylitis. Abdominal pain and bloody diarrhea are the most common symptoms of IBD.

. . . Arthritis Symptoms
Note that the arthritis symptoms may precede the IBD symptoms.

About one in five people with this disease will have inflammatory arthritis in one or more limb joints such as an arm or leg, although the lower limbs are more commonly affected. The severity of the peripheral arthritis normally coincides with the severity of the IBD, thus when diarrhea and abdominal pain are flaring, the peripheral arthritis tends to flare as well.

About one in six people with IBD also has spinal inflammation, although this inflammation is independent of the severity of the bowel disease symptoms. In many, this may just be arthritis in the sacroiliac (SI) joints, but in about five percent of people, the entire spine is involved, as it is in AS.

Studies show that people with enteropathic arthritis have a hereditary disposition to inflammatory bowel disease, but no specific gene has been discovered to account for this type of arthritis. Inflammatory bowel disease causes ulcers and microscopic abscesses in the colon or throughout the intestinal tract. It may result from an immune response to intestinal bacteria that gain access to the body through an inflamed bowel.

Treatment usually involves medication, exercise and good posture practices. Both the IBD component and arthritis component must be treated, and there are medications now available that can treat both. A rheumatologist is the type of physician who most commonly will help outline a treatment regimen, but a gastrointenologist may also be needed to help treat the IBD component of the disease.

. . . Medication NSAIDs are commonly used to help reduce the pain and stiffness in the joints. However, these medications are often not an option for some people with IBS because they can irritate the intestinal lining and actually intensify the inflammation.

Other medications such as sulfasalazine can effectively control not only pain and joint swelling in the extremities, but also the intestinal lesions in IBD. The drug is less helpful in treating arthritis of the spine for those who do have spinal involvement.

A newer class of biologic medications, the TNF inhibitors, have shown great promise in treating spondylitis. One of these medications, Infiximab (Remicade), has been approved by the FDA in the treatment of Crohn's disease as well as for ankylosing spondylitis. It has been shown to be effective in reducing the joint inflammation associated with enteropathic arthritis.

. . . Exercise & Posture
Regular daily exercises can help create better posture and flexibility as well as help lessen pain.

A properly trained physical therapist with experience in helping those with ankylosing spondylitis and related diseases can also help with treatment and can be a valuable guide in regards to exercise.

Practicing good posture techniques can help avoid some of the possible complications of this disease, especially in those with spinal involvement.

. . . Heat/Cold
Applying heat to stiff joints and tight muscles can help reduce pain and soreness. Applying cold to inflamed areas can help reduce swelling. Hot baths and showers can also help provide relief.

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...less medical jargon in a 'Quick Glance' format!