Gut and spondyloarthropathies

Area of Science:

• Gastroenterology
• Rheumatology
• Microbiology

Background:

• A strong link exists between the gut and spondyloarthropathies, ranging from reactive arthritis (ReA) triggered by enteritis to ankylosing spondylitis and peripheral arthritis associated with Crohn's disease and ulcerative colitis.
• Ileocolonoscopy reveals significant inflammatory changes in the terminal ileum or colon in a high proportion of patients with chronic seronegative oligoarthritis or sacroiliitis.
• These gut changes can present as acute inflammation or infection, with approximately 25% of patients showing chronic lesions suggestive of early Crohn's disease.

Purpose of the Study:

• To explore the connection between gut inflammation and spondyloarthropathies.
• To evaluate the efficacy of different treatment modalities for spondyloarthropathies with gut involvement.

Main Methods:

• Review of existing literature on the gut-spondyloarthropathy axis.
• Analysis of findings from ileocolonoscopy in patients with spondyloarthropathies.
• Consideration of treatment outcomes for various therapeutic approaches.

Main Results:

• Gut inflammation is a frequent finding in patients with prolonged or chronic spondyloarthropathies.
• Conventional treatments like NSAIDs and physiotherapy are standard, but antimicrobial therapy for acute ReA does not alter arthritis course.
• Prolonged antimicrobial therapy with tetracyclines may benefit patients with chlamydia arthritis.
• Sulfasalazine emerges as a logical treatment option for spondyloarthropathies with significant gut involvement.

Conclusions:

• The gut plays a critical role in the pathogenesis of spondyloarthropathies.
• Targeting gut inflammation, potentially with sulfasalazine, is a promising therapeutic strategy for spondyloarthropathies.
• Further research into the gut microbiome's influence on spondyloarthropathies is warranted.