Background/Purpose:

Enteropathic arthropathy refers to the pattern of inflammatory arthritis seen in association with gastrointestinal pathology. Arthritis in the presence of inflammatory bowel disease can occur in patients with Ulcerative Colitis and Crohn’s disease. Typically, patients may present with an asymmetrical pauciarticular pattern of joint disease in conjunction with flares of bowel disease. Anti-cyclic citrullinated (Anti-CCP) antibodies are highly specific in patients with rheumatoid arthritis and its presence is often used as a diagnostic marker, but an association with inflammatory bowel disease remains unclear.  We explore the prevalence of Anti-CCP and rheumatoid factor (RF) antibodies in patients with enteropathic arthritis.

Methods:

A retrospective analysis was performed using data collected from consecutive  patients with enteropathic arthritis attending general rheumatology clinic. Baseline demographic data, history and duration of bowel disease, treatment, pattern of inflammatory arthritis, and Anti-CCP and RF titres were recorded. Anti-CCP antibodies were detected using a commercially available fluorescence enzyme immunoassay (Phadia). The same data set were also recorded for consecutive patients with inflammatory bowel disease in the absence of arthritis. 

Results:

Full demographic data and characteristics were obtained from 31 patients with enteropathic arthritis and 30 patients without arthritis. In the study population 55% had a diagnosis of Crohn’s disease (n=17) and 45% had Ulcerative Colitis (n=14). 26% patients had axial involvement only, 48% presented with peripheral joint disease only (n=15), 26% had evidence of both peripheral and axial disease. Of the patients with peripheral joint involvement, 22% patients were found to be positive for Anti-CCP antibodies (n=5) with small joint involvement and no evidence of erosive disease on radiological assessment.  Table 1 demonstrates demographic data in patients with enteropathic arthritis.

The prevalence of Anti-CCP and rheumatoid factor antibodies in the control group was 0.

Conclusion:

Our results suggest that Anti-CCP antibodies may also be present in patients with enteropathic arthritis who have a small joint peripheral arthritis in the absence of axial disease. These patients may initially be incorrectly diagnosed with rheumatoid arthritis, rather than articular manifestations of their underlying bowel disease, as the pattern of joint involvement is similar. Further investigation with larger numbers is required to explore the association between inflammatory bowel disease and Anti-CCP antibodies.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/anti-cyclic-citrullinated-peptide-antibodies-and-inflammatory-bowel-disease/