title: Italian Expert Panel on the management of patients with coexisting spondyloarthritis and inflammatory bowel disease.
abstract: Spondyloarthritis (SpA) is a group of diseases with similar clinical, radiologic and serologic features, including SpA associated with inflammatory bowel disease (IBD-associated SpA). Several studies have estimated the occurrence of SpA in IBD patients as ranging from 17% to 39%, confirming that SpA is the most frequent extra-intestinal manifestation in patients with IBD. In this paper, the expert panel presents some red flags to guide clinicians - both rheumatologists and gastroenterologists - to make a correct diagnosis of IBD-associated SpA in clinical practice. IBD-associated SpA classification, clinical presentation and diagnostic work-up are also presented. From the therapeutic point of view, only separate recommendations/guidelines are currently available for the treatment of Crohn's disease, ulcerative colitis and for both axial and peripheral SpA. However, when IBD and SpA coexist, the therapeutic strategy should be modulated to take into account the variable manifestations of IBD in terms of intestinal and extra-intestinal features, and the clinical manifestations of SpA, with particular attention to peripheral enthesitis, dactylitis and anterior uveitis. To our knowledge, this is the first attempt to define therapeutic algorithms for the integrated management of different IBD-associated SpA clinical scenarios.
authors.affiliation: Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Italy.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Olivieri
authors.affiliation: Division of Rheumatology, Misericordia e Dolce Hospital, Prato, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cantini
authors.affiliation: Gastroenterology Unit, University Federico II, Naples, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Castiglione
authors.affiliation: IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Felice
authors.affiliation: IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gionchetti
authors.affiliation: IBD Unit, Internal Medicine, A.O. Ospedali Riuniti "Villa Sofia-Cervello", Palermo, Italy.
authors.forename: Ambrogio
authors.initials: A
authors.lastname: Orlando
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scarpa
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato, Department of Biomedical Sciences for the Health, University of Milan, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vecchi
authors.affiliation: IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy. Electronic address: alearmuzzi@yahoo.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Armuzzi
mesh_terms: D000465:Algorithms; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D007596:Joints / Q000276:immunology / Q000473:pathology; D012074:Remission Induction; D025241:Spondylarthritis / Q000150:complications / Q000453:epidemiology / Q000628:therapy*
keywords: Crohn's disease; Inflammatory bowel disease; Integrated management; Spondyloarthritis; Therapeutic algorithm; Ulcerative colitis