[Beyond the gut: articular involvement in inflammatory bowel disease]

Extraintestinal manifestations (EIMs) are a key component of the clinical burden of inflammatory bowel disease (IBD), with articular involvement being the most common and one of the main contributors to functional impairment and reduced quality of life. Despite its clinical relevance, its pathogenesis remains incompletely understood. Current evidence supports the existence of a gut-joint axis, involving immune dysregulation, genetic susceptibility, and alterations in the intestinal microbiota. Articular involvement in IBD encompasses a broad spectrum of manifestations, including both peripheral and axial forms, with heterogeneous clinical presentations that may precede, accompany, or occur independently of intestinal activity. This variability contributes to diagnostic delays and under-recognition in clinical practice. In this context, early identification of clinical features and a deeper understanding of the underlying mechanisms are essential to improve diagnostic accuracy and therapeutic strategies. This article aims to provide an updated review of the literature on articular involvement in IBD, integrating recent advances in pathophysiology and highlighting key clinical aspects for its suspicion, diagnosis, and management.