What is arthropathy?

What is Arthropathy?

Arthropathy is a general term for any disease or disorder affecting the joints, encompassing both inflammatory and degenerative joint conditions. 1

General Definition and Scope

Arthropathy refers to joint disease of any etiology and includes a broad spectrum of conditions:

• Inflammatory arthropathies involve active joint inflammation with pain, swelling, and effusion, such as those associated with inflammatory bowel disease, which are generally non-erosive 1
• Degenerative arthropathies include osteoarthritis, characterized by cartilage loss, subchondral bone changes, and joint space narrowing 1
• Crystal arthropathies involve crystal deposition in joints, such as calcium pyrophosphate deposition disease (CPPD) seen in hemochromatosis 1, 2

Classification by Joint Involvement

Arthropathies are classified based on anatomical distribution:

Axial Arthropathy

• Involves the spine and sacroiliac joints, including sacroiliitis and ankylosing spondylitis 1
• Diagnosed by inflammatory back pain with MRI or radiographic evidence of sacroiliitis 1
• Radiological sacroiliitis occurs in 20-50% of inflammatory bowel disease patients, but progressive ankylosing spondylitis develops in only 1-10% 1

Peripheral Arthropathy

• Type I (pauciarticular): Affects fewer than five large joints asymmetrically, primarily weight-bearing joints (ankles, knees, hips), with acute self-limiting symptoms lasting less than 10 weeks 1
• Type II (polyarticular): Affects five or more joints symmetrically, predominantly small joints of the hands, with persistent symptoms lasting months to years 1

Disease-Specific Arthropathies

IBD-Associated Arthropathy

• Belongs to the seronegative spondyloarthropathy group of conditions 1
• Type I correlates with intestinal disease activity, while Type II runs independently of bowel inflammation 1
• Diagnosis is clinical, based on signs of inflammation (pain, swelling, effusion) and exclusion of rheumatoid arthritis, osteoarthritis, and connective tissue diseases 1

Hemochromatosis Arthropathy

• Characterized by degenerative changes with atypical distribution, typically affecting 2nd and 3rd metacarpophalangeal joints and ankles 1
• Features exuberant osteophytes, rapid cartilage loss, and chondrocalcinosis in 50% of cases 1
• Does not respond to phlebotomy and can develop even on maintenance therapy 1

Osteoarthritis

• The most common arthropathy, targeting knees, hips, finger interphalangeal joints, thumb bases, first metatarsophalangeal joints, and spinal facet joints 1, 3
• Presents with coarse crepitus, bony enlargement, reduced range of movement, and joint-line tenderness 3

Key Clinical Pitfalls

• Distinguish arthropathy from arthralgia: Arthropathy requires objective evidence of joint inflammation (swelling, effusion), not just pain 1
• Differentiate from other conditions: Must exclude rheumatoid arthritis, osteoarthritis, connective tissue diseases, corticosteroid-induced osteonecrosis, and drug-induced lupus-like syndromes 1
• Imaging findings alone are insufficient: Diagnosis requires clinical correlation, as radiographic abnormalities may not correlate with symptoms 1