The Joint-Gut Axis Exploring the Orthopaedic and Rheumatologic Manifestations of Inflammatory Bowel Disease

Inflammatory bowel diseases (IBD) are chronic immunemediated inflammatory conditions involving the gastrointestinal system with potential to adversely affect the musculoskeletal system as well. The numerous overlapping immunogenic and pathophysiologic disease mechanisms of the gastrointestinal and musculoskeletal systems have led to the concept of the "Joint-Gut Axis," illustrating an intimate link between the two organ systems. A solid understanding of the Joint-Gut Axis is necessary for the rheumatologist as well as the orthopaedic surgeon, as concomitant musculoskeletal disease may impart a profoundly negative impact on the quality of life of patients with IBD. Furthermore, a significant subset of patients initially present with secondary musculoskeletal symptoms resulting from an underlying, undiagnosed IBD. Additional non-inflammatory musculoskeletal sequelae of IBD that are not typically attributed to the Joint-Gut Axis should also be recognized by rheumatologists and orthopaedic surgeons in order that the proper preventative and supportive interdisciplinary management may be employed, maximizing patient outcomes and quality of life.