Synopsis
Recognise peripheral and axial arthritis associated with inflammatory bowel disease, distinguish activity-linked from independent patterns, and coordinate treatment so joint control does not worsen intestinal disease.
- Inflammatory bowel disease may cause activity-linked asymmetric lower-limb oligoarthritis, more persistent small-joint polyarthritis, enthesitis, dactylitis or axial spondyloarthritis.
- Ask whether joint symptoms track bowel activity, but do not assume controlled diarrhoea excludes active axial or peripheral disease.
- Examine joints, entheses, digits and spine and ask about uveitis, psoriasis, bleeding, weight loss, perianal disease and current IBD medicines.
Key red flags
Immunosuppression, biologic treatment, central access or systemic illness heightens concern for infection in one acutely hot joint.
Investigation priorities
Define whether peripheral, axial and entheseal activity parallels objective intestinal inflammation.
Management branches
Lower-limb synovitis occurs with objective intestinal inflammatory activity and no septic-joint signal.
- Assess hydration, infection, bleeding, bowel severity and joint distribution and obtain appropriate blood, stool and synovial tests.
- Coordinate IBD treatment optimisation with gastroenterology and provide local or systemic joint symptom care that does not worsen bowel or renal risk.
Key medicines
SulfasalazineStart 500 mg once daily and increase the total daily dose by 500 mg each week as tolerated, usually to 1 g twice daily, under the specialist monitoring plan.
AdalimumabUlcerative colitis: 160 mg at week 0, 80 mg at week 2, then 40 mg subcutaneously every other week from week 4. Crohn disease: 80/40 mg, or 160/80 mg when rapid response is required with greater adverse-event risk, then 40 mg every other week from week 4.