Enteropathic Arthritis

What is enteropathic arthritis?

Enteropathic arthritis (EnA) is a type of arthritis that occurs with inflammatory bowel disease (IBD). The condition is also called enteropathic arthropathy.

Arthritis is a chronic condition involving swelling and pain in the joints. IBD is chronic inflammation of all or part of your digestive tract. If you have EnA, you have both chronic swelling in your joints and inflammation in part of your digestive tract.

EnA is one type of spondyloarthropathy, a long-term (chronic) disease of the joints.

Who might get enteropathic arthritis?

Enteropathic arthritis occurs in about 1 of every 5 people with IBD, such as ulcerative colitis and Crohn’s disease.

It also may be associated with other conditions that affect the small intestine:

• Whipple disease, a rare bacterial infection.
• Celiac disease, an autoimmune disorder.
• Intestinal bypass surgery.
• Inflammation after infection with Salmonella, Shigella or another bacteria.

What causes enteropathic arthropathy?

Scientists are unsure what causes enteropathic arthritis. They suspect it’s related to a protein called HLA-B27 on the outside of white blood cells. The protein can cause your immune system to attack healthy cells in your joints.

What are the symptoms of enteropathic arthritis?

EnA affects the gastrointestinal (GI) system and the joints.

Enteropathic arthritis symptoms involving the GI system include:

• Abdominal pain.
• Blood in your stool (poop).
• Frequent diarrhea.
• Weight loss.

Arthritis symptoms usually affect your arms and legs but sometimes include your spine. The signs include:

• Deformity (for example, fingers that are bent or bumpy).
• Pain.
• Redness.
• Stiffness.
• Swelling.
• Tenderness.
• Warmth.

A person may experience GI symptoms first, then joint symptoms, or vice versa. Or both types of symptoms may flare up at the same time.

How is enteropathic arthritis diagnosed?

Enteropathic arthritis diagnosis requires:

• Discussion of symptoms.
• Physical exam.
• Review of personal health history and family medical history.

There is no specific enteropathic arthritis test, but your healthcare provider may order certain procedures to confirm that IBD and inflammatory arthritis are both present. Or tests may identify another cause of your symptoms. These tests may include:

• Arthrocentesis, which takes a sample of synovial fluid from your joints for testing.
• Bacteria culture test of your stool.
• Biopsy of tissue from your digestive tract.
• Blood tests that identify inflammation, such as erythrocyte sedimentation rate or C-reactive protein.
• Blood tests to look for HLA-B27.
• Colonoscopy.
• X-rays of the joints that are tender or painful.

How is enteropathic arthritis treated?

Enteropathic arthritis treatment aims to relieve symptoms in the digestive tract and the joints. It also can prevent further joint damage.

Strategies to treat the joints include:

• Disease-modifying antirheumatic drugs (also called DMARDs), which can alter the immune system and slow the disease. Examples include methotrexate, sulfasalazine, hydroxychloroquine and leflunomide.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), which can lessen pain and swelling. Examples include ibuprofen, naproxen and celecoxib.
• Tumor necrosis factor-alpha inhibitors, such as etanercept and infliximab.
• Physical therapy to improve function, as well as prevent joint damage and deformity.
• Surgery to correct the spine in severe cases.

Strategies to relieve or prevent digestive symptoms include medications and lifestyle changes, particularly to your diet.

How can I prevent enteropathic arthritis?

Because scientists don’t fully understand the causes of enteropathic arthropathy, there are no proven strategies to prevent it.

What is my enteropathic arthritis prognosis?

The outlook with EnA varies widely. The symptoms can be constant, or they may come and go. Flare-ups can range from bothersome to debilitating.

But most people with enteropathic arthritis lead productive lives and have a normal lifespan.

How do I take care of myself with enteropathic arthritis?

Although EnA can affect your daily life, certain strategies can help you feel better and be more productive:

• Apply heat to relax muscles and cold to reduce joint pain.
• Choose anti-inflammatory foods and beverages.
• Exercise and stretch regularly.
• Maintain good posture by sitting and standing straight.
• Stop smoking and using tobacco products.
• Try complementary therapies such as massage, meditation, acupuncture, guided imagery and relaxation.
• Participate in support groups to connect with other people with arthritis, IBS or both.

What’s a good enteropathic arthritis diet?

Certain dietary changes may help you feel and function better. Consume more:

• Fiber, including fiber supplements.
• Fruits low in fructose (bananas, citrus, grapes and berries).
• Grains.
• Nuts.
• Probiotics.
• Veggies.
• Water (eight 8-ounce glasses every day).

Also, try tracking what you eat and seeing whether certain things cause flare-ups. Some things that tend to irritate IBS are:

• Caffeine (found in coffee, chocolate, tea, soda, energy drinks and certain medications).
• Fruits high in fructose (apples, pears and fruit juices).
• Lactose (found in cheese, milk and ice cream). But be sure to get calcium from other sources, such as spinach, salmon and supplements.
• Red peppers and green onions.
• Red wine.

A note from Cleveland Clinic

Enteropathic arthritis is a type of arthritis associated with inflammatory bowel disease. Symptoms affect both the joints and the gastrointestinal system. But medications and lifestyle modifications can help you manage pain, inflammation, digestive issues and flare-ups. Talk with your provider about ways to manage symptoms.