Arthritis or vasculitis as presenting symptoms of Crohn's disease.
OBJECTIVE
The aim of this study was to describe arthritis or vasculitis as initial manifestations of Crohn's disease (CD).


METHODS
We describe three cases in which the rheumatological manifestations preceded the bowel disease and one with rheumatological manifestation and asymptomatic gut inflammation. The information on clinical manifestations, laboratory examination results, imaging procedures, and histological data were gathered from the patients' medical charts. A MEDLINE search for the associations of extraintestinal manifestations of inflammatory bowel disease was performed.


RESULTS
Arthritis or vasculitis preceded the bowel disease by 3 to 15 months. In one case, the bowel disease remained asymptomatic throughout the follow-up period.


CONCLUSIONS
Rheumatological presentations of CD such as arthritis and vasculitis are uncommon. The diagnosis of CD without evident bowel symptoms might offer explanations and treatment options for puzzling symptoms and signs. Recognition, early diagnosis, and treatment of the underlying gut disease might prove useful for both the bowel disease and the rheumatological manifestations.
Mader
Reuven
R
Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula 18101, Israel. Mader_r@clalit.org.il
Segol
Ori
O
Adawi
Muhammed
M
Trougoboff
Philippe
P
Nussinson
Elchanan
E
D000293:Adolescent; D000328:Adult; D001168:Arthritis / Q000175:diagnosis* / Q000209:etiology; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014657:Vasculitis / Q000175:diagnosis* / Q000209:etiology