Enteropathic arthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesEnteropathic arthritisSCE Rheumatology

A 33-year-old man with ulcerative colitis develops episodic asymmetric knee and ankle swelling that flares with bowel activity. RF and anti-CCP are negative. Sacroiliac radiographs are normal and stool cultures are negative. Colonoscopy confirms active colitis. What is the most likely diagnosis?

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Correct answer: B — IBD-associated peripheral arthritis

The best answer is “IBD-associated peripheral arthritis”. IBD-associated peripheral arthritis is best because asymmetric lower-limb oligoarthritis tracking bowel activity is characteristic of IBD-associated peripheral arthritis. haemochromatosis targets MCP joints and chondrocalcinosis with iron overload; gonococcal infection would present with migratory tenosynovitis, rash or positive sexual health tests; RA is less likely with episodic lower-limb oligoarthritis linked to colitis activity; gout requires crystals or typical recurrent podagra. Clinical pearl: type 1 peripheral enteropathic arthritis often parallels intestinal inflammation. The competing options represent related diagnoses, tests or treatments, but they do not match the decisive phenotype, safety constraint or management point in this stem.

Reference: NICE NG65 spondyloarthritis recommendations: https://www.nice.org.uk/guidance/ng65/chapter/Recommendations