In patients with CD who develop new-onset arthritis, should it be attributed to shared immune pathways and treated with methotrexate or should separate rheumatologic evaluation be considered

What is known

- Crohn's rheumatic manifestations include synovitis that parallels bowel activity plus chronic polyarthritis, sacroiliitis, and spondylarthritis that evolve independently of the bowel disease. ¹ - Atypical enteropathic arthropathy can mimic rheumatoid arthritis with negative rheumatoid factor, ANA, and HLA-B27, complicating attribution. ² - Adult-onset Still's disease in a Crohn's patient produced polyarthritis and rash easily misdiagnosed as enteropathic arthritis, underscoring the value of separate rheumatologic assessment. ³ - IBD and inflammatory joint diseases share predisposing factors and immune over-activity but can be maintained by different immunological pathways. ⁴

What is unknown / caveats

- IBD and inflammatory joint disease share features but can be maintained by different immunological pathways ⁴ - No comparative trial in the excerpts evaluating methotrexate versus other agents for new-onset arthritis in Crohn's - Methotrexate appears only within individual case reports of IBD-related or juvenile arthritis, not as a head-to-head-tested strategy ^5,6 - Excerpts do not define a diagnostic algorithm for when to refer to rheumatology - The excerpts describe overlapping and distinct arthritis patterns but do not establish which patients benefit from methotrexate versus another approach.

## References

1. Deshayes P, Geffroy Y, Houdent C, Hetcketsweiler P, Colin R, Cavelier B, Monconduit M, Ropartz C. [Rheumatic manifestations in 80 cases of Crohn's disease]. Rev Rhum Mal Osteoartic. 1976. PMID: 1084009.

2. Norton KI, Eichenfield AH, Rosh JR, Stern MT, Hermann G. Atypical arthropathy associated with Crohn's disease. Am J Gastroenterol. 1993. PMID: 8503395.

3. Kono M, Oshitani N, Sawa Y, Watanabe K, Kamata N, Oiso R, Inagawa M, Kawachiya T, Kawashima D, Sogawa M, Jinno Y, Watanabe K, Higuchi K, Matsumoto T, Arakawa T. Crohn's disease complicated by adult-onset Still's disease. J Gastroenterol. 2003. PMID: 14564635.

4. De Galan C, Truyens M, Peeters H, Mesonero Gismero F, Elorza A, Torres P, Vandermeulen L, Amezaga AJ, Ferreiro-Iglesias R, Holvoet T, Zabana Y, Reverter LP, Gonzales GB, Geldof J, Varkas G, De Vos M, Lobatón T. The Impact of Vedolizumab and Ustekinumab on Articular Extra-Intestinal Manifestations in Inflammatory Bowel Disease Patients: A Real-Life Multicentre Cohort Study. J Crohns Colitis. 2022. PMID: 35442433.

5. Li GM, Liu HM, Guan WZ, Xu H, Wu BB, Sun L. Expanding the spectrum of A20 haploinsufficiency in two Chinese families: cases report. BMC Med Genet. 2019;20(1):124. PMID: 31299923.

6. Edupuganti S, Khine S, Gupta R, Yadav D, Singh A. Secukinumab-Induced Crohn's Disease in a Patient Treated for Juvenile Idiopathic Arthritis. Cureus. 2023. PMID: 37736437.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._