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Clinical management of rheumatologic conditions co-occurring with inflammatory bowel diseases.
Expert Rev Clin Immunol 2018; 14(9):751-759ER

Abstract

INTRODUCTION

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 contraindicated in IBD. Thiopurines are not effective for the treatment of articular symptoms. Several agents have been recently introduced for the treatment of IBD, such as vedolizumab, a gut-selective anti-α4β7integrin, and ustekinumab, an anti-interleukin 12/23. Their effects on SpA still need to be clarified; however, the possible contemporary administration of biologics with different molecular targets is becoming an intriguing option to cover multiple inflammatory manifestations in the same patient and is worthy of further investigation.

Authors+Show Affiliations

a IBD Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli IRCCS , Università Cattolica del Sacro Cuore , Rome , Italy.a IBD Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli IRCCS , Università Cattolica del Sacro Cuore , Rome , Italy.a IBD Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli IRCCS , Università Cattolica del Sacro Cuore , Rome , Italy.a IBD Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli IRCCS , Università Cattolica del Sacro Cuore , Rome , Italy.b Dipartimento di Medicina Interna , Università degli studi dell'Aquila , L'Aquila , Italy.c Department of Internal Medicine, Gastroenterology Division, Fondazione Policlinico A. Gemelli IRCCS , Università Cattolica del Sacro Cuore , Rome , Italy.a IBD Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli IRCCS , Università Cattolica del Sacro Cuore , Rome , Italy.a IBD Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli IRCCS , Università Cattolica del Sacro Cuore , Rome , Italy.a IBD Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli IRCCS , Università Cattolica del Sacro Cuore , Rome , Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30118354

Citation

Felice, Carla, et al. "Clinical Management of Rheumatologic Conditions Co-occurring With Inflammatory Bowel Diseases." Expert Review of Clinical Immunology, vol. 14, no. 9, 2018, pp. 751-759.
Felice C, Pugliese D, Papparella LG, et al. Clinical management of rheumatologic conditions co-occurring with inflammatory bowel diseases. Expert Rev Clin Immunol. 2018;14(9):751-759.
Felice, C., Pugliese, D., Papparella, L. G., Pizzolante, F., Onori, E., Gasbarrini, A., ... Armuzzi, A. (2018). Clinical management of rheumatologic conditions co-occurring with inflammatory bowel diseases. Expert Review of Clinical Immunology, 14(9), pp. 751-759. doi:10.1080/1744666X.2018.1513329.
Felice C, et al. Clinical Management of Rheumatologic Conditions Co-occurring With Inflammatory Bowel Diseases. Expert Rev Clin Immunol. 2018;14(9):751-759. PubMed PMID: 30118354.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical management of rheumatologic conditions co-occurring with inflammatory bowel diseases. AU - Felice,Carla, AU - Pugliese,Daniela, AU - Papparella,Luigi Giovanni, AU - Pizzolante,Fabrizio, AU - Onori,Eugenia, AU - Gasbarrini,Antonio, AU - Rapaccini,Gian Lodovico, AU - Guidi,Luisa, AU - Armuzzi,Alessandro, Y1 - 2018/09/08/ PY - 2018/8/18/pubmed PY - 2019/6/25/medline PY - 2018/8/18/entrez KW - Extra-intestinal manifestation KW - inflammatory bowel disease KW - multidisciplinary management KW - paradoxical arthritis KW - spondyloarthritis KW - therapy SP - 751 EP - 759 JF - Expert review of clinical immunology JO - Expert Rev Clin Immunol VL - 14 IS - 9 N2 - INTRODUCTION: 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 contraindicated in IBD. Thiopurines are not effective for the treatment of articular symptoms. Several agents have been recently introduced for the treatment of IBD, such as vedolizumab, a gut-selective anti-α4β7integrin, and ustekinumab, an anti-interleukin 12/23. Their effects on SpA still need to be clarified; however, the possible contemporary administration of biologics with different molecular targets is becoming an intriguing option to cover multiple inflammatory manifestations in the same patient and is worthy of further investigation. SN - 1744-8409 UR - https://www.unboundmedicine.com/medline/citation/30118354/Clinical_management_of_rheumatologic_conditions_co_occurring_with_inflammatory_bowel_diseases_ DB - PRIME DP - Unbound Medicine ER -