Rheumatic manifestations of inflammatory bowel disease

Abstract

This article reviews the literature concerning rheumatic manifestations of inflammatory bowel disease (IBD), including common immune-mediated pathways, frequency, clinical course and therapy. Musculoskeletal complications are frequent and well-recognized manifestations in IBD, and affect up to 33% of patients with IBD. The strong link between the bowel and the osteo-articular system is suggested by many clinical and experimental observations, notably in HLA-B27 transgenic rats. The autoimmune pathogenic mechanisms shared by IBD and spondyloarthropathies include genetic susceptibility to abnormal antigen presentation, aberrant recognition of self, the presence of autoantibodies against specific antigens shared by the colon and other extra-colonic tissues, and increased intestinal permeability. The response against microorganisms may have an important role through molecular mimicry and other mechanisms. Rheumatic manifestations of IBD have been divided into peripheral arthritis, and axial involvement, including sacroiliitis, with or without spondylitis, similar to idiopathic ankylosing spondylitis. Other periarticular features can occur, including enthesopathy, tendonitis, clubbing, periostitis, and granulomatous lesions of joints and bones. Osteoporosis and osteomalacia secondary to IBD and iatrogenic complications can also occur. The management of the rheumatic manifestations of IBD consists of physical therapy in combination with local injection of corticosteroids and nonsteroidal anti-inflammatory drugs; caution is in order however, because of their possible harmful effects on intestinal integrity, permeability, and even on gut inflammation. Sulfasalazine, methotrexate, azathioprine, cyclosporine and leflunomide should be used for selected indications. In some cases, tumor necrosis factor-alpha blocking agents should be considered as first-line therapy.

The role of gut microbiota (commensal bacteria) and the mucosal barrier in the pathogenesis of inflammatory and autoimmune diseases and cancer: contribution of germ-free and gnotobiotic animal models of human diseases

“…116 The frequent occurrence of arthritis in patients suffering from IBD suggests participation of the gut in this immune mediated rheumatic disorder. 117 Infection with intestinal microbial pathogens such as Salmonella, Shigella and Yersinia precedes the development of reactive arthritis; these infections can trigger autoimmune reactions in joints. 118 Moreover, increased level of antibodies directed against antigens of certain species of gut bacteria (e.g.…”

Translational 18F-FDG PET/CT Imaging to Monitor Lesion Activity in Intestinal Inflammation

“…Frequently, extraintestinal manifestations such as arthritis occur (2,3). The evaluation of disease activity is critical for both initiation and monitoring of drug treatment.…”

Histopathological features of gastrointestinal mucosal biopsies in children with juvenile idiopathic arthritis

“…Another speculation about overrepresentation of systemic onset or ERA could be that in most of the cases, intestinal symptoms precede or coexist with joint manifestations, but in some patients, arthritis precedes the gut manifestations, even by several years (13). This could be investigated further by prospectively collecting data on GI symptoms in a large cohort of JIA patients.…”

“…The alteration in function and regulation of these molecules may have an important role in initiation of these diseases. Additionally, increased intestinal permeability has been reported in patients with spondyloarthropathy and IBD, which may alter the local immune response to bacterial antigens or abnormal responses to certain microorganisms (13). There is also evidence of an increased angiogenesis.…”

“…Changes commonly found in both groups are a high expression of E-cadherin in the gut or toll-like receptors, a T-helper type 1 (Th1) predominance in the intestinal mucosa, increased proportion of Th17 cells, and dysfunction of regulatory T cells (13). The alteration in function and regulation of these molecules may have an important role in initiation of these diseases.…”