Continuing Medical Education: Spondyloarthropathies.

Edited By: Gregory C. Gardner, M.D.
Last updated Friday, January 07, 2005

Other types of spondyloarthropathies

Juvenile ankylosing spondylitis

Late onset peripheral spondyloarthropathy

Enteropathic spondylitis

1. Inflammatory Bowel Disease
   • Peripheral arthritis: Both Crohn's disease and ulcerative colitis can be associated with a peripheral arthritis in about 20% of patients. The large joints of the lower extremities are typically affected and the arthritis waxes and wanes with the activity of the bowel disease. The peripheral arthritis is not a HLA B27 associated process.
   • Spondylitis: About 20% of patients may have evidence of sacroilitis and some 20% of these patients may progress on to actual ankylosing spondylitis. Only 50% of patients with sacroilitis carry the HLA B27 haplotype. The course of the spondylitis does not correlate with the bowel activity.
2. Whipple's Disease

   Arthritis is the presenting complaint in 60% and occurs at some time in 90% of patients with Whipple's disease. The arthritis is a migratory oligoarthritis. Patients also have an increased prevalence of sacroilitis and ankylosing spondylitis. Diagnosis is made by the history of persistent diarrhea and possibly protean other manifestations, along with PAS positive material in the lamina propria of the gut on biopsy. Treatment is with prolonged antibiotics.

3. Bowel Bypass Arthritis-Dermatitis Syndrome

   Intestinal bypass for obesity has been associated with a interesting syndrome of arthritis and dermatitis occurring in 8-36% of patients. The arthritis in typically oligoarticular in nature and very painful. The etiology is felt to be due to immune complexes containing bacterial products from the gut. Dermatitis is also present in up to 80%. Treatment is with NSAIDs, antibiotics to reduce bacterial load, or reanastomosis of the bowel.

Undifferentiated spondyloarthropathy

This category is used to include those patients who do not fit any particular category of disease or may have a combination of features. Many of these patients may have a chronic inflammatory monoarthritis in the setting of B27 haplotype, heel pain caused by calcaneal periosititis, or recurrent dactylitis (sausage digits).

Uveitis is a feature of almost all of the spondyloarthropathies to one degree or another. Any young male who presents to an ophthalmologist with uveitis should be evaluated for a spondyloarthropathy.

Surgery for arthritis at the University of Washington

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