Rheumatoid arthritis (RA) is a symmetrical joint inflammation, whereas Crohn's disease (CD) is characterized by granulomatous inflammation. Combining seropositive RA with axial spondyloarthritis (SpA) and human leukocyte antigen (HLA)-B27 positive CD is a rare occurrence. We report the case of a 64-year-old male patient with RA and axial SpA experienced diarrhea recently. He had previously experienced joint pain, swelling, and inflammatory type neck, back, and bilateral hip pain. The patient had discontinued treatment and failed to attend follow-up appointments. He had swollen joints, abdominal distension, tenderness, and inflammatory bowel disease. Colonoscopy revealed numerous linear ulcers in the terminal ileum and aphthous ulcers in the ileocecal valve and sigmoid colon. Histopathological examination indicated active ileitis signs consistent with CD. The patient responded well to subcutaneous anti-tumor necrosis factor (TNF) alpha therapy. This case emphasizes that skeletal involvement in CD can develop before bowel complaints, and patients with axial SpA experiencing bowel symptoms should be closely monitored for potential signs of inflammatory bowel disease.
Tombak et al. (2026) studied this question.