Enteropathic arthritis (EA), or enteroarthritis, is a type of spondyloarthritis that occurs in people with inflammatory bowel disease (IBD) or other gastrointestinal conditions.
Spondyloarthritis is a term that refers to inflammatory conditions that can affect the back, neck, larger joints, and internal organs, such as the intestines. EA is a form of chronic inflammatory arthritis associated with IBD.
The two most common forms of IBD are ulcerative colitis and Crohn’s disease. Evidence suggests that roughly 1 in 5 people with either condition will develop EA.
While scientists are still unsure about the cause of EA, research suggests that it may involve genetics and bacterial infections in the gut.
In this article, we will discuss EA, including its types, symptoms, and treatment.
Experts typically divide the symptoms associated with EA into IBD symptoms and arthritic symptoms.
IBD symptoms
Symptoms of IBD may vary depending on the type, location, and severity of the condition.
Also, people may experience flares, during which symptoms worsen, and other periods with few or no symptoms.
Some common symptoms of IBD may include:
Arthritis symptoms
Symptoms of arthritis typically involve inflammation of the joints, which causes pain, stiffness, and reduced mobility.
With EA, this normally occurs in the joints of the limbs or spine. Some people may also experience sacroiliitis, which is inflammation of the sacroiliac joints, or where the spine and pelvis connect.
The severity of arthritic symptoms in the joints of the limbs usually coincides with the severity of IBD, while symptoms in the spine typically occur independently of IBD.
In some cases, the arthritic symptoms may precede the symptoms of IBD.
The two main types of EA are peripheral and axial. These terms indicate the type of joints the conditions affect.
Axial EA develops in the spine and pelvis. By contrast, peripheral EA involves the joints of the arms and legs.
Axial EA occurs in roughly
A doctor can
To confirm a diagnosis of IBD, such as ulcerative colitis or Crohn’s disease, a doctor may use blood tests, stool cultures, or a colonoscopy.
A blood test may also help in detecting signs of inflammation, such as C-reactive proteins.
Additionally, a blood test may show the presence of HLA-B27 on the surface of a person’s white blood cells. Experts associate the HLA-B27 gene with a number of conditions, including EA.
Testing samples of synovial fluid, which is the fluid that lubricates joints, and taking X-rays of the affected areas can also help with the diagnosis.
The most significant risk factors for EA are genetics and certain infections.
While scientists are still not sure what causes EA, some evidence suggests chronic inflammation in the intestines from IBD damages the bowel. This in turn may allow bacteria to enter the bowel wall and circulate through the bloodstream.
The body’s reaction to these bacteria may result in inflammation of the joints.
Research is still ongoing, but one 2021 review notes that certain bacterial infections, such as Salmonella or shigella, can raise the risk of joint inflammation.
Spondyloarthritis conditions also tend to run in families, indicating a potential genetic factor. People who test positive for the HLA-B27 gene are more likely to develop EA than those who do not.
Other potential risk factors for developing arthritis in people with IBD
- an active bowel disease
- a family history of IBD
- an appendectomy, which is surgery to remove the appendix
- smoking
- extraintestinal complications of IBD, which are symptoms occurring outside of the gut, such as in the skin, bones, or eyes
Similar to treatment for other forms of spondyloarthritis, treatments for EA typically involve medication, exercise, physical therapy, posture exercises, and other options that can help relieve joint inflammation and pain.
However, in the case of EA, a doctor may need to adjust medication to ensure it does not interact with treatments for IBD or exacerbate its symptoms.
The medications a doctor may suggest include:
- sulfasalazine
- methotrexate
- corticosteroids, such as prednisone
- biologics, such as tumor necrosis factor inhibitors, IL-17 inhibitors, and IL-12/23 inhibitors
In people with EA, regular exercise may help improve posture, stiffness, pain, fatigue, breathing capacity, and overall function.
This is true of physical therapy as well, which may also
EA is a condition that may occur in people with IBD, such as ulcerative colitis and Crohn’s disease.
There are two main types of EA, with each affecting different joints. Axial EA develops in the spine, while peripheral EA develops in the joints of the limbs.
Researchers are unclear on the exact cause of EA. However, evidence suggests that inflammation and damage to the intestines from IBD may allow certain bacteria to enter the bloodstream and cause inflammation in the joints.
People with the HLA-B27 gene are also more likely to develop EA.
A doctor can use medical history, physical exams, and a number of tests to diagnose the condition.
Treatment will typically involve a combination of medications, exercise, and physical therapy to help reduce inflammation and maintain mobility.