Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment  

作　　者：George E Fragoulis Christina Liava Dimitrios Daoussis Euangelos Akriviadis Alexandros Garyfallos Theodoros Dimitroulas 

机构地区：[1]First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens,"Laiko" General Hospital [2]Institute of Infection, Immunity & Inflammation, University of Glasgow [3]4~(th) Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki [4]Department of Internal Medicine, Division of Rheumatology, Patras University Hospital

出　　处：《World Journal of Gastroenterology》2019年第18期2162-2176,共15页世界胃肠病学杂志（英文版）

摘　　要：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. Extraarticular 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 coexistence of these conditions and ideally follow-up these patients in combined clinics.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. Extraarticular 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 coexistence of these conditions and ideally follow-up these patients in combined clinics.

关 键 词：SPONDYLOARTHROPATHIES Axial SPONDYLOARTHROPATHIES PERIPHERAL SPONDYLOARTHROPATHIES ANKYLOSING SPONDYLITIS Inflammatory BOWEL disease 

分 类 号：R[医药卫生]