PERIPHERAL ARTHROPATHIES IN INFLAMMATORY BOWEL-DISEASE - THEIR ARTICULAR DISTRIBUTION AND NATURAL-HISTORY

Background-Peripheral arthropathy is a well-recognised complication of inflammatory bowel disease (IBD). Little is known of its natural hist ory but a variety of joint involvement has been described, from large joint pauciarticular arthropathy to a rheumatoid pattern polyarthropat hy. Aims-To classify the peripheral arthropathies according to pattern of articular involvement, and study their natural history and clinica l associations. Methods-The case notes of all patients attending the O xford IBD clinic were reviewed, and information on general disease cha racteristics, extraintestinal features, and arthropathy extracted. Thi s was confirmed by direct patient interview using questionnaires at ro utine follow up. Patients with recorded joint swelling or effusion wer e classified as type 1 (pauciarticular) if less than five joints were involved and type 2 (polyarticular) if five or more were involved. Pat ients without evidence of swelling were classified as arthralgia. Resu lts-In total, 976 patients with ulcerative colitis (UC) and 483 with C rohn's disease (CD) were reviewed. Type 1 occurred in 3.6% of patients with UC (83% acute and self-limiting) and in 6.0% of those with CD (7 9% self-limiting); 83% and 76%, respectively, were associated with rel apsing IBD. Type 2 occurred in 2.5% of patients with UC and 4.0% of th ose with CD; 87% and 89%, respectively, caused persistent symptoms whe reas only 29% and 42%, respectively, were associated with relapsing IB D. Conclusion-Enteropathic peripheral arthropathy without axial involv ement can be subdivided into a pauciarticular, large joint arthropathy , and a bilateral symmetrical polyarthropathy, each being distinguishe d by its articular distribution and natural history.