The evolution of spondyloarthropathies in relation to gut histology. III. Relation between gut and joint.
OBJECTIVE
To study prospectively the clinical evolution of different forms of spondyloarthropathy (SpA) in relation to the evolution of gut histology in consecutive ileocolonoscopic biopsy specimens.


METHODS
Ileocolonoscopy was performed in 49 patients with SpA (34 men, 15 women). They also underwent clinical, laboratory, and radiological examinations. Two to 9 years later, a 2nd and sometimes a 3rd or 4th ileocolonoscopy was performed, and the other examinations were repeated.


RESULTS
At first ileocolonoscopy, 34 patients (69%) showed inflammatory gut lesions. At the 2nd ileocolonoscopy, 16 patients (32%) were in clinical remission; none were found to have inflammatory gut lesions. Of the 33 patients with persistent locomotor inflammation, 14 had persistent inflammatory gut lesions, predominantly the chronic type. Of these 14 patients, 6 had developed inflammatory bowel disease (IBD). None of the 15 patients with an initially normal gut histology had gut inflammation at 2nd examination. Of the 9 with initially acute lesions, 3 developed chronic lesions (1 Crohn's disease). Initial chronic lesions in 25 patients persisted in 9, of whom 5 had developed IBD. Seven of the 19 patients with non-SpA ankylosing spondylitis (non-AS-SpA) developed ankylosing spondylitis (AS); all had initially presented inflammatory gut lesions, which persisted at 2nd examination. In the 11 patients with more than 2 consecutive ileocolonoscopies, clinical remission was always associated with normal gut histology, and flares of the joint disease were related temporally to the reappearance of gut inflammation.


CONCLUSIONS
This study demonstrates the close relationship between gut and locomotor inflammation in SpA. Clinical remission was always associated with normal gut histology, whereas active locomotor inflammation was usually associated with the presence of gut inflammation. Absence of gut inflammation in the SpA is a good prognostic indicator, since gut inflammation or IBD never develops in these patients. Evolution of non-AS-SpA to full blown AS or of uncomplicated SpA to a form of IBD was always associated with gut inflammation at disease onset.
Mielants
H
H
Department of Rheumatology, Ghent University Hospital, Belgium.
Veys
E M
EM
Cuvelier
C
C
De Vos
M
M
Goemaere
S
S
De Clercq
L
L
Schatteman
L
L
Gyselbrecht
L
L
Elewaut
D
D
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001171:Arthritis, Juvenile / Q000150:complications / Q000473:pathology; D015535:Arthritis, Psoriatic / Q000150:complications / Q000473:pathology; D016918:Arthritis, Reactive / Q000150:complications / Q000473:pathology; D002648:Child; D002908:Chronic Disease; D003106:Colon / Q000473:pathology*; D003108:Colonic Diseases / Q000175:diagnosis / Q000209:etiology; D005260:Female; D052776:Female Urogenital Diseases / Q000150:complications / Q000473:pathology; D015395:Histocompatibility Antigens Class I / Q000097:blood; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000209:etiology; D007082:Ileum / Q000473:pathology*; D015212:Inflammatory Bowel Diseases / Q000209:etiology / Q000473:pathology*; D007592:Joint Diseases / Q000150:complications / Q000473:pathology*; D008297:Male; D052801:Male Urogenital Diseases; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012812:Sigmoidoscopy; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000473:pathology*
D015395:Histocompatibility Antigens Class I