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Enteropathic Arthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathyEnteropathic ArthritisSCE Rheumatology

A 40-year-old man with established ulcerative colitis develops acute asymmetric synovitis of the right knee and both ankles during a documented colitis flare. He had no joint symptoms while his bowel disease was in remission. He has no inflammatory back pain or sacroiliac symptoms and no preceding intercurrent gastrointestinal or genitourinary infection. Which statement best describes this articular pattern?

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Correct answer: D — This is type 1 peripheral arthritis, which usually parallels active bowel disease

This is the classic type 1 phenotype of IBD-associated peripheral arthritis: acute, asymmetric oligoarthritis affecting large lower-limb joints and occurring in parallel with active bowel disease. It is usually self-limiting and often improves when intestinal inflammation is controlled. Type 2 disease is instead a chronic, commonly symmetrical polyarthritis that is relatively independent of bowel activity, making B incorrect. Axial spondyloarthritis may occur with IBD but generally follows a course independent of intestinal activity, so C reverses the relationship. A incorrectly generalises the behaviour of type 2 and axial disease to all IBD-associated arthritis. Reactive arthritis requires an appropriate preceding infection and is not the best explanation for synovitis coinciding with an established ulcerative colitis flare.

Reference: Schwartzman M et al. Spondyloarthritis in inflammatory bowel disease cohorts: systematic literature review and critical appraisal of study designs, section 'Peripheral joint disease in IBD: sub-phenotype evaluation'. RMD Open. 2022;8:e001777. https://pubmed.ncbi.nlm.nih.gov/9577346/