Arthritis related to ileal pouchitis following total proctocolectomy for ulcerative colitis

Objective: To draw attention to arthritis that developed in patients who un derwent total proctocolectomy with ileal pouch construction for ulcerative colitis (UC). Methods: The course of 4 patients who developed arthritis for the first tim e after ileal-anal pouch anastomosis is described, In addition, the relatio nship to the chronic inflammation of the pouch-pouchitis-is discussed. Results: The clinical manifestations were very similar to seronegative arth ritis affecting mainly the joints of the lower extremities. It was accompan ied by enthesopathy (2 patients) and by sacroiliitis (2 patients). All had active pouchitis, The abnormal laboratory test results were nonspecific, in dicating chronic inflammation. All 4 patients tested negative for human leu kocyte antigen (HLA) B27, and none had other concomitant extraintestinal ma nifestations, Steroids rapidly improved both the arthritis and pouchitis; h owever, disease-modifying antirheumatic drugs were required to maintain rem ission with minimal daily steroids, Flares of the arthritis were always ass ociated with active pouchitis, but the opposite was not necessarily true. Conclusions: Arthritis related to ileal pouchitis after total colectomy for UC has many similarities to the arthritis associated with inflammatory bow el disease and should be added to the list of enteropathic arthropathies. S emin Arthritis Rheum 30:242-248 Copyright (C) 2001 by W.B. Saunders Company .