Therapy of spondylarthropathy in inflammatory bowel disease.
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 TNFalpha 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.
Generini
S
S
Department of Internal Medicine, Section of Rheumatology, University of Florence, Italy. cerinic@unifi.it
Fiori
G
G
Matucci Cerinic
M
M
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D008565:Membrane Proteins; D011451:Prostaglandin-Endoperoxide Synthases; D012459:Salicylates / Q000627:therapeutic use; D025242:Spondylarthropathies / Q000188:drug therapy* / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001688:Biological Products; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007166:Immunosuppressive Agents; D007527:Isoenzymes; D008565:Membrane Proteins; D012459:Salicylates; D014409:Tumor Necrosis Factor-alpha; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases