Crohn’s Disease Presenting with Acute Monoarthritis: A Case Report

Öz

Inflammatory bowel disease (IBD) is a systemic disease and is accompanied by extraintestinal findings in up to 50% of cases. Extraintestinal findings occur before the diagnosis of IBD in only 6% of cases. Findings aren’t always related to the degree of inflammation in the intestine and can be seen without intestinal symptoms. Musculoskeletal pathologies are seen in 6-46%; arthritis is more common in Crohn's patients with colonic involvement than ulcerative colitis; it can be classified as type 1 arthropathy, which is usually acute, asymmetric, and frequently involves a single large joint such as the knee joint, and type 2 arthropathy, which is symmetric and involves multiple small joints such as the metacarpophalangeal joints. Type 1 arthropathy develops in most cases of IBD accompanied by arthritis, and the rate is only about 5%. Joint findings are mostly related to IBD activity, usually self-limiting for up to 10 weeks, and may rarely occur before intestinal symptoms. In this case report, a 23-year-old male patient with acute monoarthritis as the first symptom and diagnosed with Crohn's disease is presented, emphasizing that it should be kept in mind that conditions such as peripheral arthritis of unknown cause may be an extraintestinal symptom of IBD.

Anahtar Kelimeler

• Inflammatory bowel disease
• Extraintestinal symptom
• Peripheral arthritis
• Monoarthritis
• Ileitis.

Akut Monoartrit İle Prezente Crohn Hastaliği: Bir Olgu Sunumu

Öz

İnflamatuar barsak hastalığı (IBH) sistemik bir hastalık olup, %50’ye varan oranlarda ekstraintestinal bulgular da eşlik eder. Ancak, olguların yalnızca %6 kadarında ekstraintestinal bulgular IBH tanısından önce otaya çıkar. Bulgular her zaman barsaktaki inflamasyon derecesiyle ilişkili değildir ve intestinal semptom olmadan da görülebilir. Kas-iskelet sistemi patolojileri %6-46 oranında görülür; artrit, ülseratif kolite göre kolonik tutulumlu crohn hastalarında daha sık olup; genellikle akut, asimetrik, 5’ten az eklemi etkileyen, sıklıkla diz eklemi gibi ek bir büyük eklemi içeren tip 1 artropati ve simetrik, metakarpofalangeal eklemler gibi 5 veya daha fazla küçük eklemi içeren tip 2 artropati olarak sınıflandırılabilir. Artrit eşlik eden IBH olgularının çoğunda tip 1 artropati gelişir ve oran yalnızca %5 kadardır. Bulgular çoğunlukla IBH aktivitesiyle ilişkilidir, genellikle 10 haftadan kısa sürede kendi kendini sınırlar ve nadiren intestinal semptomlar başlamadan önce ortaya çıkabilir. Bu olgu-raporun ile, ilk bulgusu akut monoartrit olan ve crohn tanısı konan, 23 yaşında bir erkek hasta sunularak, sebebi ortaya konamayan periferik artrit gibi durumların, inflamatuar barsak hastalıklarının bir ekstraintestinal semptomu olabileceği ayırıcı tanılarda akılda tutulması gerektiği vurgulanmıştır.

Anahtar Kelimeler

• İnflamatuar barsak hastalığı
• Ekstraintestinal semptom
• Periferik artrit
• Monoartrit
• İleit.

Kaynakça

1. 1. Jose FA, Garnett EA, Vittinghoff E, Ferry GD, Winter HS, Baldassano RN, Kirschner BS, Cohen SA, Gold BD, Abramson O, Heyman MB. Development of extraintestinal manifestations in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis. 2009;15(1):63-8.
2. 2. Vavricka SR, Rogler G, Gantenbein C, Spoerri M, Prinz Vavricka M, Navarini AA, French LE, Safroneeva E, Fournier N, Straumann A, Froehlich F, Fried M, Michetti P, Seibold F, Lakatos PL, Peyrin-Biroulet L, Schoepfer AM. Chronological Order of Appearance of Extraintestinal Manifestations Relative to the Time of IBD Diagnosis in the Swiss Inflammatory Bowel Disease Cohort. Inflamm Bowel Dis. 2015;21(8):1794-800.
3. 3. Rogler G, Singh A, Kavanaugh A, Rubin DT. Extraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management. Gastroenterology. 2021;161(4):1118-1132.
4. 4. Galbraith SS, Drolet BA, Kugathasan S, Paller AS, Esterly NB. Asymptomatic inflammatory bowel disease presenting with mucocutaneous findings. Pediatrics. 2005;116(3):e439-44.
5. 5. Hammoudeh M, Elsayed E, Al-Kaabi S, Sharma M, Elbadri M, Chandra P, Abu Nahia N, Hammoudeh S. Rheumatic manifestations of inflammatory bowel diseases: A study from the Middle East. J Int Med Res. 2018;46(9):3837-3847.
6. 6. Palm Ø, Moum B, Jahnsen J, Gran JT. The prevalence and incidence of peripheral arthritis in patients with inflammatory bowel disease, a prospective population-based study (the IBSEN study). Rheumatology (Oxford). 2001;40(11):1256-61.
7. 7. Wang CR, Tsai HW. Seronegative spondyloarthropathy-associated inflammatory bowel disease. World J Gastroenterol. 2023;29(3):450-468.
8. 8. De Keyser F, Elewaut D, De Vos M, De Vlam K, Cuvelier C, Mielants H, Veys EM. Bowel inflammation and the spondyloarthropathies. Rheum Dis Clin North Am. 1998;24(4):785-813, ix-x.

9. 9. da Silva Júnior RT, Apolonio JS, de Souza Nascimento JO, da Costa BT, Malheiro LH, Silva Luz M, de Carvalho LS, da Silva Santos C, Freire de Melo F. Crohn's disease and clinical management today: How it does? World J Methodol. 2023;13(5):399-413.
10. 10. Fragoulis GE, Liava C, Daoussis D, Akriviadis E, Garyfallos A, Dimitroulas T. Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment. World J Gastroenterol. 2019;25(18):2162-2176.
11. 11. Dolinger M, Torres J, Vermeire S. Crohn's disease. Lancet. 2024;403(10432):1177-1191.
12. 12. Shahid Z, Brent LH, Lucke M. Enteropathic Arthritis. 2024 Apr 19. In: StatPearls [Internet: https://www.ncbi.nlm.nih.gov/books/NBK594239/ ]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 37603630.
13. 13. Gisbert JP, Chaparro M. Anti-TNF Agents and New Biological Agents (Vedolizumab and Ustekinumab) in the Prevention and Treatment of Postoperative Recurrence After Surgery in Crohn's Disease. Drugs. 2023;83(13):1179-1205.