Bowel lesions in spondyloarthritides.
The gut can play an important role in the pathogenesis of many rheumatic conditions; this is also true for spondyloarthropathies, ileocolonoscopic studies revealing the prevalence of histological gut inflammation in more than half of these patients. Furthermore, in patients with spondyloarthritis, an evolution to clinical inflammatory bowel disease has been observed in 20% of patients with an initial subclinical chronic gut inflammation, indicating that joint and bowel inflammation are somehow connected. The presence of chronic gut inflammation can be the first sign of Crohn's disease, and it is being speculated that early treatment of the gut inflammation could prevent this evolution when the appropriate drugs become available. Moreover, the medication employed in treating these patients has the potential of influencing the inflammatory bowel lesions, in a negative (NSAIDs) or positive way (DMARDs, corticosteroids, biologic agents), and there are reports trying to prove that the spondylarthropathic ileo-colonic inflammation represents, at least in part, iatrogenic COX-2 driven damage. Therefore, there are "obscure" fields regarding the issue of gut inflammation in spondyloarthropathies, which need focused research, but taking into consideration the complex treatment strategies applied in patients with these kinds of diseases, this is not an easy task to perform.
Rimbaş
M
M
Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. mrimbas@yahoo.com
Marinescu
Mădălina
M
Voiosu
M R
MR
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000009:adverse effects; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D007413:Intestinal Mucosa / Q000187:drug effects; D025241:Spondylarthritis / Q000150:complications* / Q000188:drug therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents