For clinicians

Enteropathic (IBD-associated) arthritis

enteropathic arthritis, IBD arthritis, Crohn's arthritis, ulcerative colitis arthritis

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Bottom lineBottom line: outcomes are driven mainly by IBD activity, so pre-conception bowel-disease control is the priority; co-manage with gastroenterology. Peripheral arthritis often tracks bowel activity; axial disease does not. Many therapies overlap (sulfasalazine, azathioprine, TNF inhibitors, and IBD biologics such as vedolizumab and ustekinumab) and are largely continued.

By domain

The priority: control the bowel disease ●●●○moderate evidencestrong

Active IBD at conception is the dominant risk factor for adverse pregnancy outcomes; achieve steroid-free remission before conception where possible.^[1]

Shared care with gastroenterology ●●○○low evidenceconditional

Joint rheumatology-gastroenterology management aligns medication choices across both disease domains.^[1]

Medicines ●●●○moderate evidenceconditional

Compatible options include sulfasalazine, azathioprine, and TNF inhibitors; IBD biologics vedolizumab and ustekinumab are generally continued (increasing reassuring data). Avoid methotrexate. Consider third-trimester dosing timing for high-transfer monoclonals.^{[1, 2]}

How the arthritis behaves ●●○○low evidenceconditional

Peripheral (type 1) arthritis parallels IBD activity; axial disease runs an independent course, influencing medication strategy.^[1]

After birth ●●○○low evidenceconditional

Anticipate postpartum flare of IBD and arthritis; coordinate resumption of a breastfeeding-compatible regimen across both teams.^{[1, 2]}

Key points

Point	Evidence
Pre-conception IBD remission is the strongest modifiable predictor of good outcomes.^[1]	●●●○moderate evidencestrong

References

Sammaritano LR, et al. 2020 ACR Guideline for the Management of Reproductive Health in RMD. Arthritis Rheumatol. 2020;72(3):529-556. https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/art.41191
Ruegg L, et al. EULAR recommendations for antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update. Ann Rheum Dis. 2025;84(6):910-926. https://ard.eular.org/article/S0003-4967(25)00818-0/fulltext