Postinfectious Reactive Arthropathy

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Up to 40% of patients with ulcerative colitis and Crohn's disease develop enteropathic arthritis and spondyloarthropathy that may include sacroiliac involvement. The findings in X-rays and CT and MRI scans may be similar or identical to those of AS.

The term "postinfectious reactive arthritis" refers to a peripheral, nonseptic arthritis that develops within a month of an infection somewhere else in the body. All the cultures that are obtained from the affected joints are negative. The arthropathy is usually limited to a small number of joints, develops acutely, and is asymmetric. Up to a third of these patients may develop recurrent or chronic arthropathy, sacroiliitis, and spondyloarthropathy that may resemble AS or psoriasis. Unlike AS, skip areas—spinal segments that are not affected—are seen, whereas in AS, especially in advanced cases, the whole spine is fused. Some of these patients are HLA-B27-positive. Quite commonly, patients present with an overlapping clinical picture and are diagnosed as having undifferentiated spondyloarthropathy.

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