Bowel-associated dermatosis–arthritis syndrome

Bowel-associated dermatosis–arthritis syndrome
Bowel-associated dermatosis–arthritis syndrome
Other names	Bowel bypass syndrome and Intestinal bypass arthritis–dermatitis syndrome
	Pustules and crusts around the elbows in a patient with Crohn's disease and bowel-associated dermatosis-arthritis syndrome (BADAS)
Specialty	Dermatology

Bowel-associated dermatosis–arthritis syndrome (BADAS), is a complication of

polyarthralgia), muscle aches (myalgia) and skin changes. It has been reported to occur in up to 20% of patients who had jejunoileal bypass surgery, a form of obesity surgery that is rarely performed today.^[1]

An excessive

Corticosteroids are an alternative. Surgical repair of the normal bowel transit, where possible, can be effective.^{[citation needed}

]

BADAS has later been reported in patients with inflammatory bowel disease,^[1] diverticulitis^[2] and following resection of the stomach (gastrectomy). BADAS has also been reported following

biliopancreatic diversion (a form of bariatric surgery, also known as Scopinaro procedure),^[3] and in one case, BADAS occurred in a patient with acute appendicitis.^[4] Since "bowel bypass syndrome" is not applicable to these cases, the term BADAS was coined by Jorizzo and co-authors in 1984.^[1]

Symptoms and signs

The most typical skin changes are a red patch (

interphalangeal joints of the fingers) and there can be associated tenosynovitis

, but there is no erosion or deformation in the long term.

Diarrhea may also occur.^[5]

Mechanism

Immune complexes are thought to cause blood vessel damage, attracting neutrophils into the skin and synovium in BADAS.^[6] These

neutrophils into the affected joints and skin. The effect of antibacterial therapy supports a role for bacteria in the disease mechanism (pathogenesis).^{[citation needed}

]