Spondyloarthropathy and idiopathic inflammatory bowel diseases

: Spondyloarthropathy (SpA) as observed in patients with idiopathic inflammatory bowel diseases is categorized according to the recently developed criteria of the European Spondylarthropathy Group, and belongs to a large complex of rheumatic disorders, encompassing ankylosing spondylitis, Reiter's disease, psoriatic arthritis, and reactive arthritis. It has been recognized for many years that patients with ulcerative colitis or Crohn's disease frequently have arthritic complications. The gastroenterologist should therefore carefully evaluate any symptom of peripheral or axial arthritis, in an attempt to provide an accurate diagnosis, to define a realistic prognosis, and to establish adequate therapy at an early stage. In this review, clinical and etiopathogenic aspects are analyzed, not only of patients with inflammatory bowel diseases and SpA, but also of patients developing arthritic symptoms after gastrointestinal bacterial infections (reactive arthritis). The significance of ileal mucosal inflammation as observed frequently in patients with SpA is discussed; the contribution of immunogenetic factors in the development of SpA, such as HLA-B27, is briefly reviewed. Finally, analysis is made of the different therapeutic options that are available at present.