Enteropathic Arthritis

Enteropathic arthritis (EnA) is a type of arthritis that occurs with inflammatory bowel disease (IBD). Other names for the condition include enteropathic arthropathy and IBD-related arthropathy.

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

EnA is one type of spondyloarthropathy, a chronic disease of your joints. The condition can interfere with your quality of life, but there are treatment options available.

Symptoms of enteropathic arthritis

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

Enteropathic arthritis symptoms usually affect your arms and legs, but sometimes include your spine. Symptoms affecting your joints may include:

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

Enteropathic arthropathy symptoms involving your GI system may include:

• Abdominal pain
• Blood in your poop (stool)
• Frequent diarrhea
• Unintentional weight loss

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

Enteropathic arthropathy causes

Scientists are unsure what causes enteropathic arthritis. They suspect a protein called HLA-B27 on the outside of your white blood cells may cause it. The protein can cause your immune system to attack healthy cells in your joints. But HLA-B27 isn’t specific to the disease. It can be positive in people who don’t have enteropathic arthritis.

Risk factors for enteropathic arthritis

Enteropathic arthritis occurs in about 1 in 5 people with IBD. IBD includes conditions like ulcerative colitis and Crohn’s disease.

It may also be associated with other conditions that affect your small intestine, like:

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

How doctors diagnose enteropathic arthritis

Your healthcare provider will perform a physical examination. Then, they’ll review your personal health history and ask you about your symptoms. They’ll want to know more about your joint pain and if it changes throughout the day. They’ll also ask you about GI symptoms, including changes in your bowel habits or loss of appetite.

Your provider will also want to know about your family’s medical history. They’ll specifically inquire about any IBD or arthritis in your family.

Tests that are used to diagnose enteropathic arthritis

There’s 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 poop
• Biopsy of tissue from your digestive tract
• Blood tests that identify inflammation, like 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 your digestive tract and your joints. It can also prevent further joint damage.

Treatment options may include:

• Glucocorticoids injections, which can help relieve pain and swelling
• Disease-modifying antirheumatic drugs (DMARDs), which can alter your immune system and slow the disease, like methotrexate, sulfasalazine, hydroxychloroquine and leflunomide
• Tumor necrosis factor-alpha inhibitors, like infliximab
• Physical therapy to improve function, as well as prevent joint damage and deformity
• Surgery to correct your spine, in severe cases
• Lifestyle changes, particularly to what you eat

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
• Maintain good posture by sitting and standing straight
• Participate in support groups to connect with other people who have arthritis, IBS or both
• Stop smoking and using tobacco products
• Stretch and get regular physical activity
• Try complementary therapies like massage, meditation, acupuncture, guided imagery and relaxation

What questions should I ask my healthcare provider?

Questions you may want to ask your provider include:

• What treatments do you recommend?
• Should I avoid eating certain foods?
• What can I do to prevent flare-ups?
• Will I pass this condition on to my children?

How can I prevent enteropathic arthritis?

Scientists don’t fully understand the causes of enteropathic arthropathy, so you can’t prevent the disease. But there are ways you can help prevent symptom flare-ups.

Focus on a healthy eating plan that includes lots of fresh fruits and vegetables. Try to fit some physical activity into your day. And if you smoke, quit. Talk to your healthcare provider about other ways you can reduce the number of flare-ups you experience.

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 normal lifespans.