Enteropathic arthritis, or EnA, is a form of chronic, inflammatory arthritis associated with the occurrence of an inflammatory bowel disease (IBD), the two best-known types of which are ulcerative colitis and Crohn’s disease. About one in five people with Crohn’s or ulcerative colitis will develop enteropathic arthritis.
The most common areas affected by EnA are the peripheral (limb) joints and, in some cases, the entire spine can become involved, as well. Abdominal pain and, possibly, bloody diarrhea associated with IBD are also components of the disease.
The symptoms of enteropathic arthritis (EnA) can be divided in two groups:
A diagnosis of enteropathic arthritis is made through a complete medical examination including a history of symptoms and taking into account family history. Various tests may also be done to determine the presence of an inflammatory bowel disease and inflammatory arthritis.
Currently, there is no known cure for enteropathic arthritis but there are medications and therapies available to manage the symptoms of both the arthritis and bowel components of the disease.
Many people don’t realize that the gastrointestinal tract contains the largest immune system in the body. The immune system is the body’s natural defense against foreign invaders, and it is somehow altered in people who have EnA. Some researchers believe that the long-lasting inflammation found in the intestines of people with IBD damages the bowel, which in turn may allow bacteria to enter the damaged bowel wall and circulate through the blood stream. The body’s reaction to these bacteria may cause other problems, including inflammation in the joints and/or spine, skin sores, and inflammation of the eyes. Currently, this hypothesis is neither fully understood nor confirmed by rigorous scientific study.
Spondyloarthritis diseases tend to run in families, so there is a genetic factor involved, as well. Those who test positive for the HLA-B27 genetic marker are much more likely to have spinal involvement with EnA than those who test negative.
The course and severity of EnA varies from person to person. The disease “flares” — the times when the disease is most active and inflammation is occurring — tend to be self-limiting, often subsiding after six weeks, but re-occurrences are common. In some cases, the arthritis may become chronic and destructive.
Michael Weisman, MD, FACP, rheumatologist and SAA Medical & Scientific Advisory Board Member, discusses Enteropathic arthritis or arthritis with inflammatory bowel disease.
Rheumatologist Atul Deodhar, MD discusses the relationship between the digestive system and axial spondyloarthritis, including ulcerative colitis, Crohn’s disease, and the latest research on the gut microbiome.
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