Morning Report 11/10: IBD-Associated Arthritis

Today we had one of our amazing PGY3s and future gastroenterologists present a case on IBD-Associated Arthritis. The case started with a women transferred from an outside hospital for migratory polyarthritis and rash. We had Dr Chelsea Smith from our Rheumatology Department to walk show us her approach to polyarthritis. As a team, we used the patient demographics, history and rash to work through the different categories of seronegative arthritis and diagnose the patient with IBD-Associated Seronegative Arthritis!

Teaching Points

Polyarthritis can be broken down into seropositive (positive RF and CCP ab) or seronegative arthritis.

Seronegative Arthritis includes seronegative rheumatoid arthritis, infectious arthritis, systemic rheumatoid disease, crystal arthropathy, and spondyloarthropathy. History and physical exam will help with differentiating between different types of seronegative arthritis.

IBD is associated with various extra-intestinal manifestations including arthritis and dermatologic conditions, as seen in this patient.

Erythema nodosum and pyoderma gangrenosum are the most common cutaneous manifestations of IBD, however other manifestations include Sweet Syndrome and cutaneous vasculitis (like our patient had)!

MTC 7/25 – IBD Arthropathy

HPI: A 43 year old male with untreated Crohns presented to his primary care clinic with chronic lower back pain over the last twenty years.  Given chronicity and history of IBD, the decision was made to order plain films of the lumbar spine and SI joints. Given the chronicity of symptoms, history of IBD, and imaging, the patient’s lower back pain is likely due to spondyloarthropathy. Commonly HLA-B27 positive and seronegative (RF negative), the four main spondyloarthropathies are: Psoriatic arthritis Ankylosing spondylitis IBD arthropathy Reactive arthritis IBD Arthropathy: arthritis may involve both axial and peripheral joints. Peripheral arthritis associated with IBD is further categorized into two types. Type I is a pauciarticular manifestation, typically lower extremity joints, and correlates with IBD activity.  It typically responds to treatment of IBD symptoms. Type II peripheral arthritis is polyarticular and is more likely to affect the upper extremity joints.  It does not usually correlate with IBD activity. Axial arthritis in IBD may present with inflammatory back pain

read more MTC 7/25 – IBD Arthropathy