Enteropathie Arthropathies

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Enteropathic arthropathies are arthritides that are associated with either nonspecific or infective inflammatory diseases of the intestine. Nonspecific enteropathies include ulcerative colitis, Crohn's disease, and Whipple's disease, and common i nfective enteritides are salmo-nellosis, shigellosis, and yersiniasis. The exact cause-and-effect relationship between arthritis and inflammatory intestinal diseases is not fully clarified, although both immune mechanism and articular infection either primary or secondary to intestinal infection have been implicated. In recent years the importance of a genetic role in the evolution of enteropathic arthropathies has been discussed. In this connection, it is worth noting that approximately 90% of patients with ulcerative colitis or Crohn's

Fig. 11.27A, B Usefulness of 99mTc-MDP bone scintigraphy in psoriatic arthritis. A Whole-body bone scan in an 18-year-old male shows panoramic display of asymmetrical involvement of the joints in the lower extremities and the pelvis (arrows). B Lateral pinhole scintigraph of the right calcaneus reveals areas of increased tracer uptake in the retrocalcaneal and plantar aspects denoting enthe-sopathy (arrows)

Evolution Ankylosing Spondylitis

disease with spondylitis and sacroiliitis have HLA-B27 antigen. It has been speculated that this antigen enhances susceptibility to infection or is linked to the generation of a pathoge-netic immune response. The most common radiographic changes include periarticular soft-tissue swelling and osteopenia. In addition, as in Reiter's syndrome, subchondral bone erosions, articular narrowing, and cyst formation may occur although these changes are comparatively mild. Occasionally, the spine and sacroiliac joints are affected, resembling ankylosing spondylitis.

Scintigraphy demonstrates intense tracer uptake in the sacroiliac joints, knees, and ankles as well as the calcanei as in other SNSA. In essence, the findings are not dissimilar to those of other SNSA. Whole-body scintigraphy is ideal for grasping asymmetrical, oligoarticular involvement (Fig. 11.27A) and pinhole scintigraphy is most useful for the characterization of arthritis and enthesopathy in the individual joint and bone, the knee and calcaneus in particular (Fig. 11.27B).

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