IBD considerations in spondyloarthritis

Abstract

<jats:p> Spondyloarthritis (SpA) may be regarded a family of auto-inflammatory conditions with inflammation focused on the joints. These form part of a wider family of immune-mediated inflammatory diseases, which include inflammatory bowel diseases (IBD). These conditions share common elements of pathophysiology and it is perhaps unsurprising, therefore, that individuals with SpA frequently manifest gastrointestinal inflammation, to which the physician managing the patient with SpA must be alert. In this article, we review the shared epidemiology and pathophysiology of these conditions, before discussing approaches to diagnosis and management of inflammatory gastrointestinal pathology in patients seen in rheumatology clinics. In particular, we discuss the difference between non-specific gastrointestinal inflammation commonly described in this patient group and the more specific diagnosis of Crohn’s disease or ulcerative colitis. We describe the appropriate diagnostic workup for patients suspected of having IBD. In addition, we discuss how a diagnosis of IBD can inform treatment selection, highlighting important differences in treatment choice, drug dosing, monitoring and drug safety for this particular comorbid patient population. </jats:p>

Diagnostic and Predictive Value of Immune-Related Genes in Crohn’s Disease

“…These results were consistent with previous studies (9), which further confirmed the important role of abnormal immune cells in the pathogenesis and progression of CD. The abnormal immune system is a critical contributor to the pathogenesis and progression of CD (16). During the last decades, many studies have confirmed that CD tissues often present high immune infiltration, and immune cells and immune-related genes are attractive targets for modulating CD progression (17).…”

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“…15 From a primary care perspective, early recognition, along with its extra-articular manifestations, can lead to faster time to treatment and better health outcomes, in addition to preserved joint functionality. [16][17][18] IIDs are also used in chronic conditions of the bowels [19][20][21] (eg, Crohn's disease, ulcerated colitis, diverticulitis) as well as for antirejection therapy 22 when organ transplants or grafts have been used as they suppress the autoimmune destruction. These medicines are important because they provide a lifeline towards functional mobility and improves the quality of life 23 24 for patients by relieving their pain as well as retarding disease progression.…”

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“…There is known to be a strong link between SpA and gastrointestinal inflammation, as shown by the high proportion of SpA patients with inflammatory bowel disease (IBD; approximately 10%) or microscopic gastrointestinal inflammation (approximately 50%) [ 21 ]. The two hypotheses for this link include the ‘causal’ hypothesis, which suggests that gastrointestinal inflammation causes joint inflammation, and the ‘correlative’ or ‘comorbid’ hypothesis, in which the two types of inflammation co-exist (caused by similar immunological mechanisms) [ 21 , 22 ]. The causal hypothesis does not explain how patients without gastrointestinal inflammation develop joint inflammation; however, it is possible that these patients have had transient, undetected gastrointestinal inflammation in the past [ 21 ].…”