Inflammatory bowel disease manifestations in spondyloarthritis: considerations for the clinician

ABSTRACT

Introduction

Spondyloarthropathies (SpA) are a group of inflammatory arthritis that can involve the spine and/or peripheral joints. Extra-articular manifestations, such as inflammatory bowel disease (IBD), are frequently observed within the clinical manifestations of SpA and are part of the SpA classification criteria. Evidence of IBD is observed in about 6–7% of SpA patients, and a silent, microscopic gut inflammation, could be present in up to 50% of patients. From a pathogenetic point of view, dysregulated microbiome and migration of T lymphocytes and other cells from gut to the joint (‘gut-joint’ axis) has been recognized, in the context of a common genetic background.

Areas covered

The aim of this paper is to narratively review the recent evidences on the epidemiology, classification, clinical findings, pathogenesis, diagnosis, and treatment of IBD in patients with SpA and to provide advices for both rheumatologist and gastroenterologist in the management of IBD in SpA.

Expert opinion

IBD manifestations in SpA frequently increase the burden of the disease and represent a clinical challenge, especially for the diagnosis, assessment, and treatment of patients affected by those conditions. New treatment strategies targeting both articular and intestinal manifestations are now available and may lead to a better outcome.

KEYWORDS:

• Spondyloarthritis
• inflammatory bowel diseases
• pathogenesis
• clinical manifestations

Article highlights

• Spondyloarthritis and inflammatory bowel diseases are common associated conditions.

• The presence of inflammatory bowel disease should be carefully assessed in patients with Spondyloarthritis with symptoms and signs of bowel inflammation, in order to obtain early diagnosis and a correct referral.

• Clinician needs to consider the shared pathogenetic mechanism in IBD and SpA in the management of patients, in the light of a tailored treatment.

• Treatment strategies include the use of biologic and JAK inhibitors drugs that are efficacious in the management of both conditions, possible leading to a better control of the two entities.

• Novel treatment strategies focused on intestinal dysbiosis and inflammation, including the administration of short-chat fatty acids or fecal microbiota transplant may represent future treatment approaches.

Additional information

Funding

This paper was not funded.