John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Inflammatory articular disease in inflammatory bowel disease Volume 25, issue 4, Avril 2018

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Authors
1 Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d’hépato-gastroentérologie et d’assistance nutritive, Pôle des pathologies digestives, hépatiques et de la transplantation, 67098 Strasbourg Cedex, France
2 Université de Strasbourg, INSERM UMR_1113, IRFAC (Interface Recherche Fondamentale et Appliquée en Cancérologie), FMTS (Fédération de Médecine Translationnelle de Strasbourg), 3 avenue Molière, 67200 Strasbourg, France
3 Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service de rhumatologie, Pôle M.I.R.N.E.D. (Médecine Interne, Rhumatologie, Nutrition, Endocrinologie, Diabétologie), 67098 Strasbourg Cedex, France
4 Université de Thiès, UFR des Sciences de la Santé, Ex-10e RIAOM, BP 967, Thiès, Sénégal
5 Centre Hospitalier Régional de Thiès, Service de médecine interne, 1 Avenue Malick SY Prolongée, BP : a 34, Thiès, Sénégal
* Tirés à part

During their disease course up to 50% of inflammatory bowel disease (IBD) patients [Crohn's disease (CD) and ulcerative colitis (UC)] will experience one or more extraintestinal manifestations (EIM). Inflammatory bowel disease should therefore be considered as systemic disorders affecting not only the gut but also other organs unrelated to the digestive tract. The most frequently reported EIM affect the musculoskeletal system. Arthropathies associated with IBD can roughly be divided into axial or peripheral arthropathies. Occurrence and progression of axial spondyloarthropathies are often not related to the IBD course. They are less frequently associated to HLA B27 than idiopathic ankylosing spondylitis. Only 1 to 10% of these patients will develop progressive ankylosing spondylitis with joint destruction and constitution of syndesmophytes. Their diagnosis is mainly based on magnetic resonance imaging. Peripheral arthropathies can affect all peripheral joints. Type 1 peripheral arthropathy is an acute pauci-articular (less then 5 joints) often asymmetrical arthritis, affecting large joints, and is usually associated with IBD flares. By contrast, type 2 peripheral arthropathies may affect principally a large number (≥5) of small peripheral joints, have more often a symmetrical distribution, can lead to joint destruction, and are more frequently independent of IBD activity. Treatment of musculoskeletal EIM in IBD patients should be performed in coordination with a rheumatologist. Axial spondyloarthropathies show a good response to physiotherapy and non-steroidal anti-inflammatory drugs (NSAID). However, as long-term use of NSAID should be avoided (due to their potential harmful effects), anti-TNF antibodies are considered as their treatment of choice. Peripheral arthropathies (especially type 1 peripheral arthropathies) usually regress if IBD is controlled. Anti-TNF antibodies therapy are efficient in both settings.

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