Erosive polyarthritis in Crohn's disease - Report of a case

Erosive polyarthritis in Crohn's disease is rare and raises diagnostic and pathophysiological problems. A case with destructive lesions of the shoulde rs and hips is reported in a 43-year-old woman with a 26-year history of Cr ohn's disease. Ankylosis of the spine and hips, motion range limitation of the shoulders and wrists, and boutonniere deformity of the third finger of the right hand were present. Tests were negative for rheumatoid factor and the HLA-B27 antigen. Plain radiographs showed a triple rail pattern at the spine; synostosis of the hips; and destructive lesions of the shoulders, wr ists, tarsal bones, and third proximal interphalangeal joint of the right h and. Glucocorticoid therapy was effective in suppressing the bowel symptom flares but only partially improved the joint symptoms, whose treatment reli ed mainly on nonsteroidal antiinflammatory agents and rehabilitation therap y. Erosive arthritis in Crohn's disease is frequently monoarticular, with t he hip being the most common target. It can complicate a spondylarthropathy or reveal granulomatous synovitis, Polyarticular forms pose difficult diag nostic and therapeutic challenges and add to the disability caused by the b owel disease. The potential role of genetic factors remains to be studied.