[Joint involvement in chronic inflammatory bowel disease--current diagnostics and treatment options]

Joint involvement is the most frequent extra-intestinal manifestation of chronic inflammatory bowel disease (IBD). Arthralgias are common and spondylarthropathy may affect peripheral joints, the spine as well as tendons. Clinical assessment has the greatest impact on diagnostics and therapy. In particular, a history of "inflammatory back pain" should lead to further investigations. HLA-B27 may be indicative of ankylosing spondylitis in IBD. Ultrasound and magnetic resonance imaging are preferred diagnostic modalities for the assessment of inflammation. Arthralgia often improves during treatment of IBD. In contrast, polyarticular arthritis, sacroiliitis, ankylosing spondylitis and enthesitis often require additional continuous therapy. Baseline therapy includes analgesics, intra-articular corticosteroid administration, and physiotherapy. Disease-modifying antirheumatic drugs such as sulfasalazine and methotrexate are used in polyarticular arthritis. Sulfasalazine may be effective in patients with early axial disease as well. Tumor necrosis factor (TNF) blocking agents may be employed in patients with active disease not responding to conventional treatment. For patients who fail to respond to TNF blockade, the emergence of other targets of the inflammatory cascade may provide more treatment choices in the future.