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Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2019; 25(18): 2162-2176
Published online May 14, 2019. doi: 10.3748/wjg.v25.i18.2162
Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment
George E Fragoulis, Christina Liava, Dimitrios Daoussis, Euangelos Akriviadis, Alexandros Garyfallos, Theodoros Dimitroulas
George E Fragoulis, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, “Laiko” General Hospital, Athens 11527, Greece
George E Fragoulis, Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow G128TA, United Kingdom
Christina Liava, Euangelos Akriviadis, Alexandros Garyfallos, Theodoros Dimitroulas, 4th Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Dimitrios Daoussis, Department of Internal Medicine, Division of Rheumatology, Patras University Hospital, Patras 26504, Greece
Author contributions: Fragoulis GE reviewed the literature, drafted the manuscript, designed the structure of the manuscript; Liava C reviewed the literature, drafted the manuscript; Daoussis D drafted the manuscript, critically revised the manuscript; Akriviadis E drafted the manuscript, critically revised the manuscript; Garyfallos A drafted the manuscript, critically revised the manuscript; Dimitroulas T drafted the manuscript, reviewed the literature, critically revised the manuscript, designed the structure of the manuscript.
Conflict-of-interest statement: We declare no conflict of interest.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Theodoros Dimitroulas, MD, PhD, Assistant Professor, 4th Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, Thessaloniki 54642, Greece. dimitroul@hotmail.com
Telephone: +30-231-0892169 Fax: +30-231-0818254
Received: March 22, 2019
Peer-review started: March 22, 2019
First decision: April 4, 2019
Revised: April 11, 2019
Accepted: April 19, 2019
Article in press: April 20, 2019
Published online: May 14, 2019
Abstract

Spondyloarthropathies (SpA) include many different forms of inflammatory arthritis and can affect the spine (axial SpA) and/or peripheral joints (peripheral SpA) with Ankylosing spondylitis (AS) being the prototype of the former. Extra-articular manifestations, like uveitis, psoriasis and inflammatory bowel disease (IBD) are frequently observed in the setting of SpA and are, in fact, part of the SpA classification criteria. Bowel involvement seems to be the most common of these manifestations. Clinically evident IBD is observed in 6%-14% of AS patients, which is significantly more frequent compared to the general population. Besides, it seems that silent microscopic gut inflammation, is evident in around 60% in AS patients. Interestingly, occurrence of IBD has been associated with AS disease activity. For peripheral SpA, two different forms have been proposed with diverse characteristics. Of note, SpA (axial or peripheral) is more commonly observed in Crohn’s disease than in ulcerative colitis. The common pathogenetic mechanisms that explain the link between IBD and SpA are still ill-defined. The role of dysregulated microbiome along with migration of T lymphocytes and other cells from gut to the joint (“gut-joint” axis) has been recognized, in the context of a genetic background including associations with alleles inside or outside the human leukocyte antigen system. Various therapeutic modalities are available with monoclonal antibodies against tumour necrosis factor, interleukin-23 and interleukin-17, being the most effective. Both gastroenterologists and rheumatologists should be alert to identify the co-existence of these conditions and ideally follow-up these patients in combined clinics.

Keywords: Spondyloarthropathies, Axial spondyloarthropathies, Peripheral spondyloarthropathies, Ankylosing spondylitis, Inflammatory bowel disease

Core tip: Spondyloarthropathies (SpA) are subdivided to axial and peripheral SpA with ankylosing spondylitis (AS) being the prototype disease of the former. They have many extra-articular manifestations the most common of which is bowel involvement. Inflammatory bowel disease (IBD) (silent or clinically evident) occurs much more frequently in AS compared to the general population and associates with AS disease activity. Both axial and peripheral SpA occur more frequently in Crohn’s disease than ulcerative colitis. Pathogenetic mechanisms that have been proposed to explain the link between SpA and IBD include dysregulated microbiome and migration of T lymphocytes and other cells from gut to the joint.