Ch. 21 - Arthropathies of IBD

Question 1

2 patterns of joint inflammation of IBD

Answer 1

1) Peripheral polyarthritis

2) Involvement of SI joints and axial skeleton

Question 2

T/F: In IBD, arthralgia is more common than arthritis

Answer 2

T

Question 3

Ratio of boys to girls in those with and without peripheral arthritis in IBD

Answer 3

Almost identical

Question 4

T/F There is a pronounced tendency for familial clustering in UC and CD

Answer 4

T

Question 5

T/F SI arthritis is more common in patients with IBD compared to the general population

Answer 5

T, >30x

Question 6

Peripheral polyarthritis vs SI arthritis: Associated with HLA-B27

Answer 6

SI arthritis

Question 7

Most frequently affected joint in IBD arthritis

Answer 7

Lower extremity joints, esp ankles and knees

Question 8

Usual duration of peripheral arthritis in IBD

Answer 8

1-2 weeks, and tend to recur

Question 9

Arthritis of IBD may last for months especially if

Answer 9

GI disease is active

Question 10

T/F If joint inflammation in IBD lasts for months, permanent functional loss or joint damage ensues

Answer 10

F, permanent functional loss or joint damage is unusual

Question 11

SI arthritis vs peripheral arthritis: May reflect activity and course of GI inflammation

Answer 11

Peripheral arthritis

Question 12

SI arthritis vs peripheral arthritis: More common in IBD arthritis

Answer 12

Peripheral arthritis

Question 13

T/F IBD arthritis may be accompanied by enthesitis

Answer 13

T, SI arthritis in particular

Question 14

Very painful MSK complication of IBD that occurs symmetrically in the limbs, rather than the joints, and may be accompanied by increased sweating and purplish discoloration of the affected limbs

Answer 14

Hypertrophic osteoarthropathy

Question 15

T/F Osteoporosis can take place in patients with IBD arthritis even without steroid use

Answer 15

T

Question 16

Severe form of IBD that appears to be an autoinflammatory, and is associated with treatment-resistant colitis, perianal fistula formation, folliculitis, and arthritis

Answer 16

Infantile-onset IBD

Question 17

Infantile onset IBD results from

Answer 17

Mutations in IL-10 or its receptor

Question 18

Treatment for infantile-onset IBD that may be curative

Answer 18

Hematopoietic stem cell transplantation early in the course of disease

Question 19

UC vs CD: Bloody diarrhea

Answer 19

UC

Question 20

Perianal skin tags and fistulae

Answer 20

CD

Question 21

T/F In IBD arthritis, GI symptoms usually precede joint disease by months or years

Answer 21

T

Question 22

T/F: In IBD arthritis, joint symptoms may precede GI symptoms or intestinal disease

Answer 22

T

Question 23

When arthritis precedes GI symptoms in IBD, arthritis resembles what chronic arthritides

Answer 23

JIA, JAS, or seronegative enthesopathy and arthropathy syndrome

Question 24

T/F: Mucocutaneous manifestations of IBD are less common in patients who have arthritis compared to those without arthritis

Answer 24

F, more common especially in those with peripheral arthritis

Question 25

T/F: There is a higher frequency of arthritis in children with extensive, compared to segmental, bowel disease

Answer 25

T

Question 26

T/F: Patients with IBD arthritis usually have active gut disease

Answer 26

T

Question 27

Erythema nodosum (nodular panniculitis) in IBD occur most commonly in what area

Answer 27

Subcutaneous fat of the pretibial region

Question 28

Lesions of IBD that are erythematous, painful, slightly elevated, 1-2 cm in diameter, appear in groups and reappear sequentially in new areas after several days

Answer 28

Erythema nodosum

Question 29

T/F: IBD erythema nodosum is more likely associated with SI joint involvement

Answer 29

F, Peripheral arthritis of short duration and involving a few joints

Question 30

IBD skin lesion that begins as a pustule that breaks down and rapidly enlarges to forma chronic, painful, deep undermined ulcer with a red, raised border

Answer 30

Pyoderma gangrenosum

Question 31

Lesions of IBD that if recurrent and precedes intestinal symptoms, may lead to a misdiagnosis of Behcet’s

Answer 31

Painful oral ulcerations seen particularly in CD

Question 32

T/F: IBD vasculitis can affect both small and large vessels

Answer 32

T

Question 33

Uveitis in IBD vs Spondyloarthritis: More frequent HLA-B27 positivity

Answer 33

Spondyloarthritis

Question 34

Uveitis in IBD vs Spondyloarthritis: More common episcleritis, scleritis, and glaucoma

Answer 34

IBD

Question 35

Usual characteristics of uveitis in IBD: Location, onset, duration, symptom

Answer 35

Bilateral, posterior, insidious onset, chronic duration, asymptomatic

Question 36

RF in IBD arthritis

Answer 36

Negative

Question 37

ANA in IBD arthritis

Answer 37

Negative

Question 38

Antibodies that are frequently present in the sera of children with IBD

Answer 38

pANCA and ASCA

Question 39

UC vs CD: ANCA is more common

Answer 39

UC

Question 40

T/F: Vasculitis is more common in IBD patients with positive ANCA

Answer 40

F

Question 41

WBC range in synovial fluid of adults

Answer 41

5000-15000/mm3 or 5-15x10^9/L

Question 42

Predominant cell type in the synovial fluid of patients with IBD arthritis

Answer 42

Neutrophils

Question 43

T/F: Protein, glucose, and complement levels in synovial fluid of patients with IBD arthritis are low

Answer 43

F, normal

Question 44

T/F: SI arthritis of IBD is distinguishable from that associated with juvenile AS on radiograph

Answer 44

F

Question 45

Successful management of peripheral arthritis in IBD generally depends on effective treatment of GI disease

Answer 45

T

Question 46

Successful management of HLA-B27-associated spondylitis in IBD generally depends on effective treatment of GI disease

Answer 46

F, this is more likely independent of the GI activity

Question 47

T/F: Colectomy in UC may be followed by a striking remission in peripheral joint symptoms

Answer 47

T

Question 48

Treatment for IBD peripheral arthritis that can exacerbate disease

Answer 48

NSAIDs

Question 49

NSAID alternative when NSAID exacerbates IBD

Answer 49

Selective COX-2 inhibitor

Question 50

Best management for arthropathy of IBD

Answer 50

Early sulfasalazine or glucocorticoids

Question 51

Why are sulfasalazine or glucocorticoids considered best management for IBD arthropathy

Answer 51

Beneficial effect on GI inflammation

Question 52

Treatment for persistent IBD arthritis in 1 or 2 joints

Answer 52

Intraarticular glucocorticoids

Question 53

Use of this predominantly topical steroid in CD may result in remission of joint symptoms

Answer 53

Oral budesonide

Question 54

Treatment for IBD arthropathy that can result in improvement of both GI symptoms and arthritis

Answer 54

Sulfasalazine, glucocorticoids, MTX, anti-TNF particularly infliximab

Question 55

Treatment for IBD arthropathy that may be used for patients who fail infliximab therapy

Answer 55

Adalimumab

Question 56

Patients with these chronic arthritides may have an increased risk for developing IBD

Answer 56

ERA, PsA, extended oligoarticular arthritis

Question 57

Initial drug of choice for HLA-B27 associated spondylitis of IBD

Answer 57

Sulfasalazine at 30-50mkday, max 2.5g/day

Question 58

Treatment options for patients with HLA-B27 associated spondylitis of IBD who fail initial treatment with sulfasalazine

Answer 58

MTX and anti-TNF agents

Question 59

Treatment for vasculitis associated with IBD

Answer 59

Systemic glucocorticoids

Question 60

Treatment options for IBD uveitis

Answer 60

Topical glucocorticoids, more immunosuppression with MTX and anti-TNF may be necessary

Question 61

Most important determinant of overall prognosis in the child with IBD and arthritis

Answer 61

Outcome of GI disease

Question 62

T/F: Permanent changes in the spine and hips of children with IBD arthritis with axial disease are frequent

Answer 62

T