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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

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