Arthritis in inflammatory bowel disease

Area of Science:

• Gastroenterology and Rheumatology
• Immunology
• Clinical Medicine

Background:

• Musculoskeletal manifestations, especially spondyloarthritis (SpA), are common in inflammatory bowel disease (IBD).
• The interplay between intestinal and joint inflammation presents diagnostic and therapeutic hurdles.
• Axial SpA affects a significant portion of IBD patients (6-62%), with peripheral arthritis impacting up to one-third.

Purpose of the Study:

• To review current evidence on the epidemiology, pathophysiology, and clinical features of IBD-associated SpA.
• To integrate findings on diagnostic strategies and management approaches for these complex cases.
• To highlight the importance of coordinated, multidisciplinary care.

Main Methods:

• This is a narrative review synthesizing existing literature.
• Evidence was gathered on IBD-associated axial and peripheral SpA.
• The review covers epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment.

Main Results:

• Shared pathogenic mechanisms involve genetic factors, immune dysregulation, and gut-synovium lymphocyte trafficking.
• Musculoskeletal symptoms can precede IBD diagnosis, leading to diagnostic delays.
• Current biomarkers have limitations, and treatment requires careful consideration of both intestinal and joint disease activity.

Conclusions:

• Coordinated multidisciplinary care is crucial for improving diagnostic accuracy, clinical outcomes, and patient satisfaction in IBD-SpA.
• Newer targeted therapies necessitate careful selection based on differential efficacy.
• Understanding the complex relationship between IBD and SpA is key for effective management.