Inflammatory Joint Pain in Inflammatory Bowel Disease (IBD) Patients Treated with Anti‑Tumour Necrosis Factor (TNF) Therapy: Differentiating IBD Arthritis, Paradoxical Arthritis, Anti‑TNF‑induced Lupus, and Serum-Sickness-Like Reactions

Authors

  • Vivek Govardhanam, B.Eng, MD, FRCPC Staff Gastroenterologist, Kitchener-Waterloo Health Network
  • Catherine Ivory, MD, PhD, FRCPC Senior Clinician Investigator, Ottawa Hospital Research Institute Assistant Professor, University of Ottawa, Faculty of Medicine, Department of Medicine Rheumatologist, Division of Rheumatology, The Ottawa Hospital

DOI:

https://doi.org/10.58931/cibdt.2025.3351

Abstract

Key Takeaways

• We propose a mechanism based approach assessing bowel activity, timing of drug exposure and auto-antibody profile to manage arthritis in IBD patients treated with anti-TNF therapy.

• Paradoxical arthritis, anti-TNF- induced lupus, and serum-sickness-like reaction can occur with anti-TNF therapy; all require a change in targeted therapy.

• Managing arthritis in IBD requires multidisciplinary work between gastroenterologist and rheumatologist to optimize treatment of both manifestations.

Author Biographies

Vivek Govardhanam, B.Eng, MD, FRCPC, Staff Gastroenterologist, Kitchener-Waterloo Health Network

Dr. Vivek Govardhanam is an inflammatory bowel disease (IBD) Specialist and gastroenterologist practicing in Ontario, Canada. He completed advanced fellowship training in inflammatory bowel disease with expertise in complex Crohn’s disease, ulcerative colitis, and pouch disorders. Dr. Govardhanam’s background in engineering informs his approach to precision medicine and systems-based clinical design. His academic and clinical interests include biologic sequencing, multidisciplinary models of IBD care that bridge gastroenterology, surgery, and Health equity. He is an advocate for health equity and a co-founder of the South Asian Health Network, with hopes of focusing on optimizing IBD care delivery for racialized and underrepresented patient populations.

Catherine Ivory, MD, PhD, FRCPC, Senior Clinician Investigator, Ottawa Hospital Research Institute Assistant Professor, University of Ottawa, Faculty of Medicine, Department of Medicine Rheumatologist, Division of Rheumatology, The Ottawa Hospital

Dr. Catherine Ivory is a Rheumatologist and Assistant Professor of Medicine at the University of Ottawa. She completed a PhD in basic science from McGill University before completing medical school at the University of Ottawa.  She completed Internal Medicine as well as Rheumatology at the University of Ottawa. Her clinical and academic interests focus on the Systemic Lupus Erythematosus. She is director of the Lupus Clinic at the Ottawa Hospital.

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Published

2025-12-22

How to Cite

1.
Govardhanam V, Ivory C. Inflammatory Joint Pain in Inflammatory Bowel Disease (IBD) Patients Treated with Anti‑Tumour Necrosis Factor (TNF) Therapy: Differentiating IBD Arthritis, Paradoxical Arthritis, Anti‑TNF‑induced Lupus, and Serum-Sickness-Like Reactions. Can IBD Today [Internet]. 2025 Dec. 22 [cited 2025 Dec. 26];3(3):29–35. Available from: https://canadianibdtoday.com/article/view/3-3-Govardhanam_et_al

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Volume 3, Issue 3, Fall 2025

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