Joint symptoms after restorative proctocolectomy in ulcerative colitis and familial polyposis coli

We have determined the incidence and nature of joint symptoms in patients who had a restorative proctocolectomy and ileal reservoir for ulcerative colitis (UC) and familial adenomatous polyposis (FAP); we also have recorded the effect of drug treatment and surgery on these symptoms. One hundred seventy-three patients with UC and 25 patients with FAP who had undergone a restorative proctocolectomy answered a questionnaire about joint symptoms. These were present in 96 (55%) patients with UC and five (20%) with FAP. In the 69 patients with UC with joint symptoms before proctocolectomy, 31 (45%) reported improvement after colectomy. However, in 27 (28%) patients with UC and joint symptoms, and four of five patients with FAP with joint symptoms, these started after restorative proctocolectomy. A family history of joint symptoms did not predispose to the development of arthropathy in the patients with UC but may have in patients with FAP. Before colectomy, in most patients with colitis, azathioprine or sulfasalazine did not improve joint symptoms, but steroids were effective in 18 of 64 patients who had received them. Of 101 patients (43%) with joint symptoms in either disease, 43 had symptoms sever enough to interfere with daily activities. We conclude that joint symptoms are a major cause of morbidity in patients with UC. After restorative proctocolectomy they may develop de novo in patients with either UC or FAP.