RHEUMATOLOGIC INVOLVEMENT IN INFLAMMATORY BOWEL DISEASE: UPDATED EVIDENCE ON SPONDYLOARTHRITIS AND THE CASE FOR INTEGRATED CARE
DOI:
https://doi.org/10.56238/arev7n9-243Keywords:
Inflammatory Bowel Disease, Extraintestinal Manifestations, Axial and Peripheral SpondyloarthritisAbstract
Introduction: Crohn's disease (CD) and Ulcerative Colitis (UC) are part of the group of Inflammatory Bowel Diseases (IBD), autoimmune and chronic conditions that primarily affect the gastrointestinal tract. However, extraintestinal manifestations may also be present, especially spondyloarthritis (SpA).
Purpose: This study aimed to highlight the prevalence of extraintestinal manifestations, focusing on SpA, in association with IBD, emphasizing the importance of early awareness for appropriate follow-up with specialists.
Methods: This narrative literature review was based on a clinical and epidemiological search for information on patients with CD or UC concomitant with SpA. The period covered was 2011–2025, using the databases SciELO and PubMed, with descriptors such as 'Crohn Disease,' 'Colitis, Ulcerative,' 'Inflammatory Bowel Diseases,' 'Spondyloarthritis,' 'Sacroiliitis,' 'Arthritis,' 'Prevalence,' 'Epidemiology,' and 'Frequency'.
Results and Discussion: The results reveal a significant prevalence of musculoskeletal involvement in association with IBD, with particular emphasis on the higher prevalence of axial SpA associated with CD.
Final Considerations: When present, extraintestinal manifestation associated with IBD should be diagnosed early in order to enable an integrated therapeutic management, addressing both comorbidities, with the aim of reducing morbidity and mortality in these patients, preventing disease progression, and providing quality of life through appropriate case management and follow-up by gastroenterology and rheumatology specialists.
Downloads
References
Alvarado-Julio, A., et al. (2022). Oral manifestations associated with inflammatory bowel disease and early endoscopic findings in patients with spondyloarthritis. BMC Oral Health, 22, 477. https://doi.org/10.1186/s12903-022-02497-4
Benfaremo, D., Luchetti, M. M., & Gabrielli, A. (2019). Biomarkers in inflammatory bowel disease-associated spondyloarthritis: State of the art and unmet needs. Journal of Immunology Research, 2019, 8630871. https://doi.org/10.1155/2019/8630871
Fatica, M., et al. (2024). Impact of biological therapy in reducing the risk of arthritis development in inflammatory bowel diseases. RMD Open, 10(1), e003820. https://doi.org/10.1136/rmdopen-2023-003820
Felice, C., et al. (2019). Red flags for appropriate referral to the gastroenterologist and the rheumatologist of patients with inflammatory bowel disease and spondyloarthritis. Clinical and Experimental Immunology, 196(1), 123–138. https://doi.org/10.1111/cei.13246
Felice, C., et al. (2023). Cytokines in spondyloarthritis and inflammatory bowel diseases: From pathogenesis to therapeutic implications. International Journal of Molecular Sciences, 24(4), 3957. https://doi.org/10.3390/ijms24043957
Fragoulis, G. E., et al. (2019). Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment. World Journal of Gastroenterology, 25(18), 2162–2176. https://doi.org/10.3748/wjg.v25.i18.2162
Gionchetti, P., Calabrese, C., & Rizzello, F. (2015). Inflammatory bowel diseases and spondyloarthropathies. The Journal of Rheumatology, 93, 21–23. https://doi.org/10.3899/jrheum.150628
Hammoudeh, M., et al. (2018). Rheumatic manifestations of inflammatory bowel diseases: A study from the Middle East. Journal of International Medical Research, 46(9), 3837–3847. https://doi.org/10.1177/0300060518781404
He, K., et al. (2025). Inflammatory bowel disease and risk of rheumatoid arthritis: A UK Biobank cohort study. International Journal of Rheumatic Diseases, 28(6), e70314. https://doi.org/10.1111/1756-185X.70314
Huber, M. K., et al. (2024). Prevalence of spondyloarthritis in inflammatory bowel disease according to ASAS and ultrasonography and its correlation with plasma calprotectin. Advances in Rheumatology, 64, 27. https://doi.org/10.1186/s42358-023-00348-6
Kesarwani, V., et al. (2024). Screening tools for spondyloarthritis in patients with psoriasis, uveitis, and inflammatory bowel disease: A scoping review. Arthritis Care & Research, 76(6), 860–870. https://doi.org/10.1002/acr.25308
Kopylov, U., et al. (2023). Impact of vedolizumab on extraintestinal manifestations in inflammatory bowel disease: Results from a descriptive, retrospective, real-world study. Inflammatory Bowel Diseases, 29(11), 1713–1722. https://doi.org/10.1093/ibd/izad075
Nag, A., et al. (2023). Role of biologic therapies in the rheumatic manifestations of inflammatory bowel disease: A systematic analysis. Cureus, 15(9), e45195. https://doi.org/10.7759/cureus.45195
Nardone, O. M., et al. (2025). The effectiveness of medical therapies for joint, skin and eye extraintestinal manifestations in IBD - An umbrella review. Alimentary Pharmacology & Therapeutics, 61(12), 1854–1871. https://doi.org/10.1111/apt.70181
Pettersson, N., et al. (2025). Spondyloarthritis features in IBD patients: Prevalence, referral trends and clinical implications. A questionnaire-based study. Scandinavian Journal of Gastroenterology, 60(7), 686–697. https://doi.org/10.1080/00365521.2025.2504076
Regner, E. H., et al. (2018). Functional intraepithelial lymphocyte changes in inflammatory bowel disease and spondyloarthritis have disease specific correlations with intestinal microbiota. Arthritis Research & Therapy, 20, 149. https://doi.org/10.1186/s13075-018-1639-3
Rohekar, S., et al. (2024). Initiation of vedolizumab did not provoke new-onset spondylarthritis in patients with inflammatory bowel disease: A prospective 24-week study with imaging assessments. United European Gastroenterology Journal, 12(7), 859–869. https://doi.org/10.1002/ueg2.12621
Sanz-Sanz, J., et al. (2025). Prevalence of undiagnosed inflammatory bowel disease in spondyloarthritis patients. Journal of Clinical Medicine, 14(13), e4569. https://doi.org/10.3390/jcm14134569
Schwartzman, M., et al. (2022). Spondyloarthritis in inflammatory bowel disease cohorts: Systematic literature review and critical appraisal of study designs. RMD Open, 8(1), e001777. https://doi.org/10.1136/rmdopen-2021-001777
Shrestha, S., et al. (2022). Association between inflammatory bowel disease and spondyloarthritis: Findings from a nationwide study in Sweden. Journal of Crohn's and Colitis, 16(10), 1540–1550. https://doi.org/10.1093/ecco-jcc/jjac065
Shrestha, S., et al. (2024). Spondyloarthritis in first-degree relatives and spouses of patients with inflammatory bowel disease: A nationwide population-based cohort study from Sweden. Journal of Crohn's and Colitis, 18(9), 1371–1380. https://doi.org/10.1093/ecco-jcc/jjae041
Sun, Y., Li, Y., & Zhang, J. (2022). The causal relationship between psoriasis, psoriatic arthritis, and inflammatory bowel diseases. Scientific Reports, 12, 20526. https://doi.org/10.1038/s41598-022-24872-5
Torres, J. A., et al. (2011). Inflammatory bowel diseases at the University Hospital of the Federal University of Sergipe: Extraintestinal manifestations. Brazilian Journal of Coloproctology, 31(2), 115–119. https://doi.org/10.1590/S0101-98802011000200001
Wang, C.-R., & Tsai, H.-W. (2023). Seronegative spondyloarthropathy-associated inflammatory bowel disease. World Journal of Gastroenterology, 29(3), 450–468. https://doi.org/10.3748/wjg.v29.i3.450
Zioga, N., et al. (2022). Inflammatory bowel disease-related spondyloarthritis: The last unexplored territory of rheumatology. Mediterranean Journal of Rheumatology, 33(1), 126–136. https://doi.org/10.31138/mjr.33.1.126
