SAVED
File name .JPG
File alt. text
Image should be px wide x px tall.
Select Image
home - IBD - Extra Intestinal Manifestations - Bone Disease Written by Dr Sebastian Zeki

Bone Disease

Metabolic bone diseaseOsteoporosis and osteopenia are common in both male and female patients with CD (20%–50%).Causes: Steroids/smoking, low physical activity, inflamm-tory cytokines, extensive small bowel disease or resection, and nutritional deficiencies.Screen with DEXA if recurrent/ prolonged steroid use Type 1 Features:Pauciarticular (<5) involvement.Painful tender swollen large joints. Type 2 Features:Polyarticular involvement.Painful symmetrical small hand joints.It persists for months.It is independent of IBD. S I 15% 15% AS 5% 5% UC Crohn'sPauci-articular large joint problems (= type 1) 10% 20% Polyarticular small joint problems (= type 2) 10% 20% Axial arthropathy (sacroiliitis)50% with colitis have abnormal xrays (but are asymptomatic). TreatmentWeight bearing, isotonic exerciseStopping smoking/ Avoid alcohol XSAdequate dietary calcium (>1 g/day)HRT not advised in post-menopausal with osteoporosis Regular use of bisphosphonates, calcitonin/ derivatives, and raloxifene may reduce or prevent further bone lossCheck testosterone in menRoutine administration of vitamin D is not warranted Therapy of arthropathies: Simple analgesics.Sulfasalazine.Local steroid injections.Physiotherapy.NSAIDS in selected cases- short term use doesnt affect colitis.For type I- Treat IBD and joint symptoms get better.For type II arthritis generally resolves with effective treatment of the colitis.For axial arthritis- Intensive physiotherapy/ sulfasalazine, and methotrexate.Infliximab for intractable or severely debilitating symptoms. Bone Disease in Inflammatory Bowel Disease Symptoms: Pain in the buttocks after rest, which then improves with movementBack pain/SI pain when springing the pelvisStarts before age of 30Lumbar lordosis and limited spinal flexionTests: MRI is diagnostic Squaring of the vertebral bodiesMarginal syndesmophytes Bony proliferation, with ankylosis producing the classical “bamboo spine”HLA B-27 in 75% with axial arthritis(HLA typing has no role however) Advanced Written by Dr Sebastian Zeki

Related Stories

Uncovering shared genetic features between inflammatory bowel disease and systemic lupus erythematosus

Paediatric Congenital Enteropathies: Clinical and Histological Review

Ultrasound for detection of complications and evaluation of treatment response in inflammatory bowel disease (IBD)?

Uncovering shared genetic features between inflammatory bowel disease and systemic lupus erythematosus

Pyoderma Gangrenosum in a Patient with Crohn's Disease Treated with Adalimumab: A Case-Based Review and Systematic Review of the Current Literature