Enteropathic Spondyloarthritis: From Diagnosis to Treatment

Abstract

Enteropathic arthritis (EA) is a spondyloarthritis (SpA) which occurs in patients with inflammatory bowel diseases (IBDs) and other gastrointestinal diseases. Diagnosis is generally established on the medical history and physical examination. It was, generally, made according to the European Spondyloarthropathy Study Group (ESSG) criteria. Rheumatic manifestations are the most frequent extraintestinal findings of IBD with a prevalence between 17% and 39%, and IBD is associated, less frequently, with other rheumatic disease such as rheumatoid arthritis, Sjogren syndrome, Takayasu arteritis, and fibromyalgia. Although the pathogenesis of EA has not been plainly clarified, the most popular theory supposes that joint inflammation occurs in genetically predisposed subjects with bacterial gut infections, provided an important evidence for a possible relationship between inflammation of the gut mucosa and arthritis. The management of patients with EA requires an active cooperation between the gastroenterologist and rheumatologist.

Impact of a multidisciplinary approach in enteropathic spondyloarthritis patients

“…Several factors may contribute to this diagnostic delay such as the initial mild joint symptoms, the use of concomitant immunosuppressive therapies for IBD and the use of the New-York criteria that do not allow a definite diagnosis at disease onset [61]. The long diagnostic delay may also be related to a late referral to a rheumatologist by both the general practitioners and consulters due to a difficulty in recognizing SpA symptoms [9]. In this context, delay in the diagnosis or misdiagnosis may result in adverse outcome for patients as progression of joint damage and morbidity as observed in AS [60].…”

“…HLA-B27 is involved in antigen presentation in the immune system and is thought to have a key role in the pathogenesis of the SpA. HLA-B27 recognizes an elevated prevalence in patients with AS, PsA, reactive arthritis, and ESpA but debated data have been reported in the studies [9,32]. ESpA pathogenesis, although initially linked to Th17, has been reported to be associated with innate like-T cell subpopulations that respond towards IL-23.…”

“…ASAS criteria were used in order to classify patients as affected by axial or/and peripheral SpA and by radiographic or nr-ax SpA [47]. The Oxford Criteria were used to classify the joint involvement in ESpA patients as follows: type 1 peripheral, type 2 peripheral and type 3 involvement (both axial and peripheral) [8,9]. The CASPAR criteria were used for psoriatic arthritis (PsA) [48], ACR criteria for Rheumatoid Arthritis [49] and EULAR/ACR criteria for Gout [50] Fibromyalgia and Osteoarthritis were diagnosed according with ACR and EULAR classification criteria [51,52].…”

“…The ASAS-endorsed recommendations for early referral of patients suspected for having axial SpA by primary care physicians or non-rheumatologists include the extra-articular manifestations (psoriasis, IBD and/or uveitis) among the parameters for a diagnosis of SpA in patients with chronic low back pain (duration ≥ 3 months) with onset before 45 years of age [6,7]. In 1998 the Oxford Criteria were proposed to classify the joint involvement in SpA patients with IBD including a type 1 peripheral arthritis that is the pauciarticular form involving fewer than 5 joints, a type 2 peripheral arthritis that is the polyarticular form involving 5 or more joints and a type 3 involvement with both axial and peripheral involvement [8,9]. Later, the joint involvement observed in IBD was usually classified mainly into two subsets: axial (including sacroileitis with or without spondylitis) and peripheral [10,11].…”

Spondyloarthritis

“…Daten aus mehreren Ileokoloskopie Studien weisen darauf hin, dass in etwa 30 % der Patienten mit SpA eine chronische Darmentzündung, wie ein frühes Stadium von MC, zu finden ist [11].…”