Arthritis in inflammatory bowel disease

Musculoskeletal manifestations, particularly spondyloarthritis (SpA), represent the most frequent extraintestinal manifestations of inflammatory bowel disease (IBD). The coexistence of intestinal and articular inflammation poses diagnostic and therapeutic challenges requiring coordinated multidisciplinary care. Axial SpA occurs in 6-62% of IBD patients, while peripheral arthritis affects up to one third of patients. The temporal relationship between intestinal and joint disease is variable, and musculoskeletal symptoms may often precede IBD diagnosis. Shared pathogenic mechanisms include genetic susceptibility, dysregulated immune pathways, intestinal barrier dysfunction and aberrant lymphocyte trafficking between gut and synovium. Diagnostic delay remains substantial and serologic biomarkers have limitations. Therapeutic algorithms must consider both intestinal and articular disease activity, with newer biologics and targeted therapies requiring careful selection due to differential efficacy across disease domains. Multidisciplinary care models improve diagnostic accuracy, clinical outcomes, and patient satisfaction. This narrative review summarizes and integrates current evidence on epidemiology, pathophysiology, clinical features, diagnostic strategies and management of IBD-associated axial and peripheral SpA.