Clinical management of rheumatologic conditions co-occurring with inflammatory bowel diseases

ABSTRACTIntroduction: Spondyloarthritis (SpA) is the most common extra-intestinal manifestation in patients with inflammatory bowel diseases (IBD). Articular disorders may also appear as ‘paradoxical’ effects during biologic therapy with anti-tumor necrosis factor (TNF).Areas covered: In this narrative review, we report the current knowledge about the pathogenesis, the diagnosis and the therapeutic management of articular diseases occurring in patients with IBD.Expert commentary: Evidence-based recommendations for the management of IBD-associated SpA and paradoxical arthritis are lacking. Then, collaboration between gastroenterologists and rheumatologists is mandatory to guarantee the best outcomes for these patients, from a prompt diagnosis to an appropriate therapeutic strategy. Among therapies currently available, steroids, sulfasalazine, methotrexate and anti-TNFs are recommended for both gastrointestinal and articular diseases, whereas non-steroidal anti-inflammatory drugs (NSAIDs) and etanercept are...