• Arthritis can sometimes begin before the diagnosis of inflammatory bowel disease.
• Peripheral joint injury is more common than axial.
Clinical Findings
joint involvement
• Axial involvement;
It occurs with similar frequency in Crohn's disease and ulcerative colitis.
o Indistinguishable from ankylosing spondylitis.
o Independent of IBD activity.
o It is closely related to HLA B27 positivity.
• Peripheral involvement;
It is more common in Crohn's disease.
o May be associated with IBD activity.
o HLA B27 positivity is low.
Extra-articular involvement
• Uveitis, erythema nodosum, pyoderma gangrenosum
Treatment
• NSAIDs are effective, but they can exacerbate IBD.
• Anti-TNF therapy is highly effective in both intestinal and joint disease.
• Secukinumab (anti IL-17) may exacerbate IBD.