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Enteropathic arthritis is a type of seronegative spondyloarthritis associated with inflammatory bowel disease (IBD), primarily Crohn’s disease and Ulcerative colitis, and occasionally other gastrointestinal conditions (celiac disease, Whipple’s disease, intestinal bypass).

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It shares features with other SpA (HLA-B27 association, sacroiliitis, enthesitis) but has a close temporal relation to bowel inflammation.

Epidemiology

• Seen in 10–20% of patients with IBD.
• Occurs in both Crohn’s disease and UC, slightly more with Crohn’s.
• Male predominance in axial disease; peripheral arthritis equally affects both sexes.

Pathogenesis

• Genetic: HLA-B27 strongly linked (esp. axial form).
• Immune: Cross-reactivity between gut bacterial antigens and joint antigens.
• Inflammatory cascade: Gut inflammation → cytokine release (TNF-α, IL-23/IL-17 axis) → synovial inflammation and enthesitis.

Clinical Features

Clinical subtypes:

• Axial Arthritis (like ankylosing spondylitis)
  • Sacroiliitis, spondylitis.
  • Usually independent of IBD activity.
  • Chronic, progressive.
  • Presents with inflammatory back pain, morning stiffness, reduced spinal mobility.
• Peripheral Arthritis: Asymmetric oligoarthritis (large joints, lower limbs).
  • Type 1: Pauciarticular, acute, self-limited, flares with IBD activity.
  • Type 2: Polyarticular, chronic, not always linked with bowel activity.

Enthesitis & Dactylitis

• Heel pain (Achilles tendon, plantar fascia).
• Sausage digits.