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Hépato-Gastro & Oncologie Digestive

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Les manifestations articulaires associées aux maladies inflammatoires chroniques de l’intestin Volume 18, issue 1, Janvier-Février 2011

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Authors
CHU de la Conception, Service de médecine interne, 147, boulevard Baille, 13005 Marseille, France, Laboratoire d’immunologie, CHU de la Conception, Marseille, France, Service de rhumatologie, CHU de la Conception, Marseille, France

Arthritis is one of the most frequent extraintestinal manifestation in inflammatory bowel disease (IBD). Among IBD patients, those with colonic and/or peri-anal involvement of a Crohn's disease (CD), those with a familial form of IBD and those with another extraintestinal manifestation are at higher risk of developing arthritis. Others diseases with prominent intestinal manifestations and arthritis have to be ruled out (i.e., Whipple's disease). Axial arthropathies include asymptomatic sacroiliitis, detected by radiography, or symptomatic spondylitis. Arthropathies have clinical course independent of IBD activity. Combined radiologic investigations are helpful to diagnose asymptomatic forms. Peripheral arthritis is oligoarticular (type I) or polyarticular (type II), with different pattern of evolution with regards to IBD activity. Nonsteroidal antiinflammatory drugs (NSAIDs) should be used with caution, for short periods, rather during IBD remission and encouraging the use of selective COX-2 inhibitors. When axial arthopathy precedes the occurrence of digestive manifestations, one must keep in mind the lack of specificity of the presence of intestinal ulcerations (sometimes due to NSAIDs) and/or anti-saccchaomyces antibodies. Anti-TNF biotherapy have a dramatic action on both intestinal and articular manifestations, and other molecules targeting cytokines recently implicated in the physiopathology of IBD, as anti-IL23, have to be evaluated. Close collaboration between gastroenterologists, rheumatologists and internists is the key to optimal care of these patients.