Inflammatory bowel disease and spondylarthropathy

The link between gastrointestinal (GI) function and overall health has been documented throughout history (1,2). It is most clearly illustrated by the inflammatory bowel diseases (IBDs) ulcerative colitis and Crohn’s disease. These are associated with both peripheral and axial arthropathies and are therefore sometimes classified within the group of spondylarthropathies (SpA), classic of which is idiopathic ankylosing spondylitis (AS). SpA usually occurs without overt signs of intestinal inflammation, but the findings of several studies (3–6) have suggested that a significant number of patients with certain forms of SpA may have asymptomatic intestinal inflammation, usually affecting the ileum. Because the pattern of joint disease seen in patients with symptomatic (IBD) and those with asymptomatic (SpA) gut inflammation is similar, it has been suggested that the intestinal inflammation may play a pathogenetic role in the arthritis and secondly that the ileal inflammation in SpA represents a subclinical form of Crohn’s disease. If correct, this suggests an important pathogenetic link between intestinal and joint inflammation. However, elucidating this link is complicated by the fact that most patients with SpA are treated with nonsteroidal antiinflammatory drugs (NSAIDs). This article reviews the clinical and etiologic similarities and differences between IBD and SpA and the possible confounding effects of NSAIDs. Enteric arthritis or arthritic enteritis?