Published online May 14, 2019. doi: 10.3748/wjg.v25.i18.2162
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
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.
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.