Therapy of spondylarthropathy in inflammatory bowel disease

S. Generini, G. Fiori, M. Matucci Cerinic

Department of Internal Medicine, Section of Rheumatology, University of Florence, Italy.

ABSTRACT
Musculoskeletal manifestations represent the most common extra-intestinal complication of inflammatory bowel diseases (IBD) and are usually included in the clinical spectrum of the spondyloarthropathies (SpA). Although control of intestinal inflammation often ameliorates articular symptoms, sometimes arthropathy is independent of the gut disease course and may require the same therapeutic options which apply to primary SpA diseases, but with caution so as not aggravate the IBD. 
At the moment, salicylates (sulphasalazine and mesalazine) and selective COX-2 inhibitors (which are preferable to traditional NSAIDs although they cannot be assumed to be safe for the gastrointestinal tract) are the first choice treatment. 
Several immunosuppressive and biological agents including methotrexate, thalidomide and TNFa antagonists have efficacy for both articular and intestinal inflammation and are currently in use for the induction of remission and for maintenance in more severe cases. New combination therapies and novel biologically-driven treatments, targeted to specific pathophysiological processes, might offer less toxicity and the potential for better treatment outcomes.

Key words
Inflammatory bowel disease, spondyloarthropathy, Crohn's disease.

Please address correspondence to: Sergio Generini, MD, Dipartimento di Medicina Interna, Sezione di Reumatologia, viale Pieraccini no. 18, 50139 Florence, Italy. 
E-mail: cerinic@unifi.it

Clin Exp Rheumatol 2002; 20: (Suppl. 28): S88-S94.
© Copyright Clinical and Experimental Rheumatology 2002.