IBD and Arthropathies: Diagnosis and Management
IBD and Arthropathies: Diagnosis and Management
Arthropathies are a major clinical problem in patients with inflammatory bowel disease (IBD). Often it is difficult to control the articular symptoms with the anti-inflammatory strategies used for IBD. Studies evaluating specific treatments aimed at articular manifestations in patients with IBD are rare. Although there has been considerable interest in the gut–joint axis over the last decade, the pathophysiological mechanisms driving IBD-associated arthropathy are still unknown. Recently, interest in the multidisciplinary approach to patients with IBD and arthropathy has been increasing. New research and clinical projects aimed at understanding the mechanisms of disease may advance the development of effective therapies. In this review, the pathophysiology of IBD-associated arthropathy is discussed, as well as clinical manifestations, the classification and current therapeutic strategies.
Arthropathies, an umbrella term for inflammatory joint manifestations and non-inflammatory peripheral joint pain, are the most common extra-intestinal manifestation in patients with inflammatory bowel disease (IBD) and these arthropathies are a major problem causing significant morbidity and disability. Articular manifestations affect approximately 30% of patients with Crohn's disease and those with ulcerative colitis. Since 1930, IBD-associated arthritis has been investigated and it was commonly accepted that peripheral arthritis associated with IBD was similar to rheumatoid arthritis (RA). However, studies on arthritis in IBD demonstrated arthritis to be a distinct clinical entity. Over the last few decades, IBD-associated arthritis is considered to be part of the group of spondyloarthritis (SpA), together with ankylosing spondylitis (AS), undifferentiated SpA, psoriatic arthritis, reactive arthritis, arthritis associated with acute anterior uveitis and idiopathic arthritis. Sixty per cent to 70% of SpA patients have gut inflammation, mainly chronic inflammation discovered by ileocolonoscopy, and 7% will develop IBD. Thus, several studies confirmed the close relationship between gut and joint inflammation suggesting a common aetiology, but the precise origin is still unknown.
In this review, the pathophysiology of the gut–joint axis in patients with IBD will be discussed. Furthermore, the clinical presentation, diagnosis, prevalence and management of joint manifestations in such patients are covered, as well as novel methods for the classification of joint manifestations.
Abstract and Introduction
Abstract
Arthropathies are a major clinical problem in patients with inflammatory bowel disease (IBD). Often it is difficult to control the articular symptoms with the anti-inflammatory strategies used for IBD. Studies evaluating specific treatments aimed at articular manifestations in patients with IBD are rare. Although there has been considerable interest in the gut–joint axis over the last decade, the pathophysiological mechanisms driving IBD-associated arthropathy are still unknown. Recently, interest in the multidisciplinary approach to patients with IBD and arthropathy has been increasing. New research and clinical projects aimed at understanding the mechanisms of disease may advance the development of effective therapies. In this review, the pathophysiology of IBD-associated arthropathy is discussed, as well as clinical manifestations, the classification and current therapeutic strategies.
Introduction
Arthropathies, an umbrella term for inflammatory joint manifestations and non-inflammatory peripheral joint pain, are the most common extra-intestinal manifestation in patients with inflammatory bowel disease (IBD) and these arthropathies are a major problem causing significant morbidity and disability. Articular manifestations affect approximately 30% of patients with Crohn's disease and those with ulcerative colitis. Since 1930, IBD-associated arthritis has been investigated and it was commonly accepted that peripheral arthritis associated with IBD was similar to rheumatoid arthritis (RA). However, studies on arthritis in IBD demonstrated arthritis to be a distinct clinical entity. Over the last few decades, IBD-associated arthritis is considered to be part of the group of spondyloarthritis (SpA), together with ankylosing spondylitis (AS), undifferentiated SpA, psoriatic arthritis, reactive arthritis, arthritis associated with acute anterior uveitis and idiopathic arthritis. Sixty per cent to 70% of SpA patients have gut inflammation, mainly chronic inflammation discovered by ileocolonoscopy, and 7% will develop IBD. Thus, several studies confirmed the close relationship between gut and joint inflammation suggesting a common aetiology, but the precise origin is still unknown.
In this review, the pathophysiology of the gut–joint axis in patients with IBD will be discussed. Furthermore, the clinical presentation, diagnosis, prevalence and management of joint manifestations in such patients are covered, as well as novel methods for the classification of joint manifestations.
