The pathogenesis of arthritis in these conditions is likely influenced by immunologic, genetic, and abnormal bowel permeability factors, though the precise mechanisms are still unknown.

Typically occurring before the age of 45, inflammatory back pain often begins slowly, is often unilateral, sporadic, and worsens while at rest.

Alternatively, by means of molecular mimicry, which involves the host's immune system reacting to these antigens in a cross-reaction with self-antigens present in the synovial membrane and other target organs, an autoimmune response may be triggered.

Clinical manifestations include dementia, polyarthralgia, low-grade fever, diarrhea, weight loss, lymphadenopathy, and neuropsychiatric symptoms.

[11] A case series comprising twenty-five patients with Whipple's disease-related arthropathy revealed that symmetric migratory polyarthritis, primarily affecting the knees, ankles, and wrists, was the most prevalent pattern.

[14] Celiac disease is a type of gluten-sensitive enteropathy marked by small intestinal mucosal abnormalities, particularly villous flattening, and atrophy, which leads to malabsorption.

Among the numerous clinical signs and symptoms of malabsorption are dermatitis herpetiformis, weight loss, diarrhea, and anemia.

[16] Large joints like the knees, hips, and shoulders are commonly affected by polyarticular symmetrical arthritis, which is the most frequently reported articular pattern.

[20] Axial along with peripheral arthritis is linked to celiac disease and can sometimes occur in adults and children[21] before or without bowel symptoms.

[23] Though mono- and oligoarthritis have also been reported, the typical clinical presentation is a migratory non-erosive seronegative polyarthritis affecting the ankles, wrists, shoulders, hands, and fingers.

[25] Intestinal bypass arthritis has been linked to the overgrowth of bacteria in the blind loop segment of the bowel, and immunologic involvement appears likely due to the presence of immune complexes in the serum.

[26] Reversing the bypass surgery is typically linked to a total and permanent remission of the arthritis, providing more proof of the connection between intestines and joint pathology.

[4] NSAIDs are usually effective in treating spondyloarthropathy patients; however, they should be used cautiously as they may worsen IBD[27] and have been linked to ulcerations in both the large and small intestines.

For ulcerative colitis, sulfasalazine has been demonstrated to be beneficial in treating flare-ups as well as the underlying condition;[29] however, the picture for Crohn's disease is less clear.

Psoriatic arthritis,[32][33] enthesopathy linked to spondyloarthropathy,[34] and refractory ankylosing spondylitis[35] can all benefit from biological blockade using the TNFa antagonists etanercept and infliximab.