Ileocolonoscopy in seronegative spondylarthropathy

Area of Science:

• Gastroenterology
• Rheumatology
• Immunology

Background:

• Seronegative spondylarthropathies (e.g., ankylosing spondylitis, reactive arthritis) are associated with gut inflammation.
• Gastrointestinal symptoms are not always present in these patients.

Purpose of the Study:

• To investigate the prevalence and characteristics of gut inflammation in patients with seronegative spondylarthropathy.
• To explore the relationship between joint symptoms and intestinal lesions.

Main Methods:

• Prospective endoscopic and histologic study of the terminal ileum and colorectum.
• Involved 211 patients with seronegative spondylarthropathy.
• Repeat ileocolonscopy in 19 patients to assess lesion evolution.

Main Results:

• Macroscopic inflammation in 30% and microscopic inflammation in 61% of patients.
• Two inflammation types: acute (infectious enterocolitis-like) and chronic.
• Chronic inflammation predominated in ankylosing spondylitis; both types equal in reactive arthritis.
• 32% of chronic inflammation cases resembled early Crohn's disease.
• Acute inflammation resolved; Crohn's-like lesions persisted.
• Joint symptoms paralleled histologic lesion evolution.

Conclusions:

• Gut inflammation is common in seronegative spondylarthropathy, irrespective of GI symptoms.
• Inflammation may increase gut permeability, leading to antigen absorption.
• Shared underlying processes may link spondylarthropathy and gut inflammation.