What are Arthritis for chronic bowel disease (ulcerative colitis and Crohn’s disease)?
Nonspecific ulcerative colitis is a chronic inflammatory process of unknown etiology that develops in the mucous membrane and submucosa of the predominantly large intestine.
Regional or granulomatous ileitis is a chronic, possibly viral, intestinal disease that covers all layers of the intestinal wall (transmural lesion), and sometimes extends to the mesentery, regional lymph nodes, affecting both the small and large intestines, but most often localized in the terminal small intestine. intestine (regional, terminal ileitis).
These diseases may be accompanied by damage to the peripheral joints, the spine, or the joints and the spine. The clinical manifestations of articular syndrome in both processes are of the same type.
Pathogenesis during Arthritis in chronic bowel disease (ulcerative colitis and Crohn’s disease)
The pathogenesis of the intestinal process and joint damage is not fully established, but it is believed that many mechanisms are involved in it and, in particular, toxic, immune, autoimmune. In the blood of patients are detected antibodies to the cells of the mucous membrane of the intestine, lymphocytotoxic antibodies, circulating immune complexes, in which, possibly, antigenic components of intestinal microbes, etc., are also involved.
In non-specific ulcerative colitis, peripheral arthritis develops equally in men and women, the process is first played out at the age of 20-40, although it may be in children and the elderly. In Crohn’s disease, articular manifestations usually occur in childhood and adolescence. The development of peripheral arthritis in these diseases is usually not associated with the carrier of the histocompatibility antigen B27.
Ankylosing spondylitis is more common in men than in women (3: 1). This disease usually develops in individuals who develop HLA B27.
Joint changes in non-specific ulcerative colitis and regional ileitis more often occur in patients with other extraintestinal manifestations of the processes — in case of ulcers of the oral mucosa, relieve, erythema nodosum, gangrenous pyoderma.
The clinical picture of peripheral arthritis is characterized by acute attacks, relapses. Usually their development coincides with the exacerbation of the underlying disease. The latter most often precedes the appearance of peripheral arthritis in several years, but sometimes arthritis is the first sign of intestinal disease. Articular manifestations – swelling, tenderness, hyperthermia of the skin above the joint, effusion in the synovial cavity of an inflammatory nature. With each attack, usually no more than three joints are affected, and the process can be migratory, often involving the knee and ankle joints; small joints of the hands and feet are rarely affected. The duration of the attack ranges from one to several months. With repeated recurrence, persistent articular degeneration may occur, which serves as the basis for differential diagnosis with RA, especially its seronegative variant. There can only be arthralgia.
Diagnosis of Arthritis in chronic bowel disease (ulcerative colitis and Crohn’s disease)
Laboratory indicators reflect mainly the activity of the intestinal process. Detect an increase in ESR, moderate anemia. RF is found no more often than in the general population. Radiological data are not indicative.
Arthritis treatment for chronic bowel disease (ulcerative colitis and Crohn’s disease)
In the treatment of articular syndrome, it may be sufficient to prescribe non-steroidal anti-inflammatory drugs, and occasionally intra-articular injections of the GCS. Preparations of gold are contraindicated.
The focus should be on the treatment of the intestinal process (sulfasalazine, salazopyridazin, etc.).
Ankylosing spondyloarthritis in non-specific ulcerative colitis and regional ileitis occurs in 5-7% of cases, and in terms of clinical and radiological symptomatology is no different from ankylosing spondylitis. His identification most often precedes the clinic intestinal lesions. The treatment of the latter does not suspend the further development of ankylosing changes in the spine. Therapeutic measures do not differ from those recommended for ankylosing spondylitis.