Enteric Arthropathy

Question 1

What is the definition of enteropathic arthritis?

Answer 1

An inflammatory arthritis associated with inflammatory bowel disease such as Crohn’s disease or ulcerative colitis.

Question 2

What proportion of patients with IBD develop enteropathic arthritis?

Answer 2

Approximately 20–40%.

Question 3

Can enteropathic arthritis occur before IBD is diagnosed?

Answer 3

Yes, it can present before, during or after IBD is identified.

Question 4

What are the three main patterns of enteropathic arthritis?

Answer 4

Axial spondyloarthritis, type 1 peripheral arthritis and type 2 peripheral arthritis.

Question 5

What symptoms characterise axial enteropathic arthritis?

Answer 5

Chronic inflammatory back pain that is worse in the morning and improves with exercise.

Question 6

Which examination findings support axial enteropathic arthritis?

Answer 6

Sacroiliac tenderness, restricted spinal movement and reduced chest expansion.

Question 7

What joints are typically affected in type 1 peripheral enteropathic arthritis?

Answer 7

Asymmetrical large joints such as knees and ankles.

Question 8

How does type 1 peripheral enteropathic arthritis relate to IBD activity?

Answer 8

It strongly correlates with active bowel inflammation and flares.

Question 9

What is the prognosis of type 1 peripheral enteropathic arthritis?

Answer 9

It is usually self-limiting and resolves without permanent joint damage.

Question 10

What pattern of joint involvement occurs in type 2 peripheral enteropathic arthritis?

Answer 10

Symmetrical polyarthritis affecting five or more small joints.

Question 11

Does type 2 peripheral enteropathic arthritis correlate with IBD activity?

Answer 11

No, it occurs independently of IBD flares.

Question 12

What is the typical course of type 2 peripheral enteropathic arthritis?

Answer 12

Chronic and migratory with potential for joint damage.

Question 13

What is enthesitis in the context of enteropathic arthritis?

Answer 13

Pain and inflammation at tendon insertion sites such as the Achilles or plantar fascia.

Question 14

What is dactylitis?

Answer 14

Diffuse inflammation and swelling of an entire finger or toe.

Question 15

Which dermatological manifestations are associated with enteropathic arthritis?

Answer 15

Erythema nodosum and pyoderma gangrenosum.

Question 16

Which ocular manifestation may present alongside enteropathic arthritis?

Answer 16

Anterior uveitis causing painful red eye with blurred vision.

Question 17

What bedside test helps identify undiagnosed IBD in patients presenting with arthritis?

Answer 17

Faecal calprotectin.

Question 18

Why is stool culture needed in suspected enteropathic arthritis?

Answer 18

To exclude infectious diarrhoea as a cause of symptoms.

Question 19

What synovial fluid findings support enteropathic arthritis over septic arthritis?

Answer 19

Mononuclear inflammatory cells, no crystals, and negative culture.

Question 20

Which inflammatory markers are typically raised in enteropathic arthritis?

Answer 20

CRP and ESR.

Question 21

Why is anti-TTG testing performed in suspected enteropathic arthritis?

Answer 21

To exclude coeliac disease, a differential for chronic diarrhoea.

Question 22

Which antibody is commonly positive in ulcerative colitis?

Answer 22

p-ANCA.

Question 23

What X-ray findings support axial enteropathic arthritis?

Answer 23

Sacroiliitis, vertebral squaring and syndesmophyte formation.

Question 24

Why is MRI preferred over X-ray in early axial enteropathic arthritis?

Answer 24

It detects active inflammation and early structural changes.

Question 25

What investigation confirms IBD if not already diagnosed?

Answer 25

Colonoscopy with or without OGD.

Question 26

Who should be involved in the management of enteropathic arthritis?

Answer 26

Rheumatology and gastroenterology specialists.

Question 27

Why is optimising bowel disease important in enteropathic arthritis?

Answer 27

It improves peripheral arthritis but not axial disease.

Question 28

What conservative therapy is essential in axial enteropathic arthritis?

Answer 28

Regular exercise and physiotherapy to maintain mobility.

Question 29

Why must NSAIDs be used cautiously in enteropathic arthritis?

Answer 29

They may worsen underlying inflammatory bowel disease.

Question 30

When are local intra-articular steroids appropriate in enteropathic arthritis?

Answer 30

For non-progressive monoarthritis.

Question 31

Which DMARDs are first-line for enteropathic arthritis?

Answer 31

Methotrexate, sulfasalazine or leflunomide.

Question 32

When should biologics be considered in enteropathic arthritis?

Answer 32

When DMARDs fail or axial disease responds poorly to conventional therapy.

Question 33

Which biologic class is most effective for axial enteropathic arthritis?

Answer 33

Anti-TNF monoclonal antibodies.

Question 34

How are concurrent joint and bowel flares managed?

Answer 34

With oral steroids that treat both inflammation types.

Question 35

What happens to peripheral arthritis after colectomy in ulcerative colitis?

Answer 35

Peripheral arthritis often resolves after colectomy, whereas axial disease does not improve.

Question 36

How does axial disease compare clinically to ankylosing spondylitis?

Answer 36

Axial enteropathic arthritis is clinically identical to ankylosing spondylitis with morning stiffness, improvement on exercise, and reduced chest expansion.

Question 37

What key feature distinguishes Type 1 peripheral arthritis from RA?

Answer 37

Type 1 enteropathic arthritis is non-erosive and does not cause permanent joint damage.

Question 38

Which biologic agents improve both IBD activity and axial arthritis?

Answer 38

Anti-TNF agents such as infliximab and adalimumab improve both bowel inflammation and axial enteropathic arthritis.

Question 39

Why must NSAIDs be used cautiously?

Answer 39

NSAIDs may worsen IBD activity, with COX-2 inhibitors sometimes preferred under specialist guidance.

Question 40

What is the typical serological profile?

Answer 40

Enteropathic arthritis is seronegative with negative rheumatoid factor and anti-CCP antibodies.

Question 41

To which disease family does it belong?

Answer 41

Enteropathic arthritis belongs to the seronegative spondyloarthropathy group associated with enthesitis, dactylitis, and acute anterior uveitis.

Question 42

With which skin condition is Type 1 arthritis strongly associated?

Answer 42

Type 1 peripheral arthritis is strongly associated with erythema nodosum during IBD flares.

Question 43

What pattern of sacroiliitis is often seen?

Answer 43

Sacroiliitis in enteropathic arthritis is often asymmetrical, unlike the typical symmetrical pattern in ankylosing spondylitis.

Question 44

What is a key limitation of methotrexate in management?

Answer 44

Methotrexate improves peripheral arthritis but has no effect on axial enteropathic arthritis, which usually requires biologic therapy.