Rudwaleit Martin, Baeten Dominique
Rheumatology, Charite-Campus Benjamin Franklin, Berlin, Germany.
Best Pract Res Clin Rheumatol. 2006 Jun;20(3):451-71. doi: 10.1016/j.berh.2006.03.010.
Between 5 and 10% of cases of ankylosing spondylitis (AS) are associated with inflammatory bowel disease (IBD), either Crohn's disease or ulcerative colitis. A much larger percentage of AS patients have subclinical gut inflammation manifested either by endoscopic findings or by histology. The association with HLA-B27 is less strong in IBD-associated AS than in idiopathic AS, and there is evidence for an association between gut inflammation in AS with the Crohn's-disease-related CARD15 mutations. Despite the different genetics, the immunopathology suggests common inflammatory pathways in gut and joint inflammation in AS, and in gut inflammation in AS and IBD. Although this observation is of interest to unravel the pathophysiology of the disease, systematic screening of AS patients by ileocolonoscopy is not indicated in the absence of gut symptomatology as only a small proportion of AS patients with subclinical gut inflammation will develop overt IBD over time. Treatment of AS associated with IBD with non-steroidal anti-inflammatory drugs (NSAIDs) is problematic because of concerns of potential re-activation of IBD by NSAIDs. Major advances have been made in recent years with the establishment of anti-tumour necrosis factor (TNF) therapy in AS, the other spondyloarthritides and IBD. Anti-TNF agents are of particular relevance to AS patients with concomitant IBD who are at risk of exacerbation of the underlying bowel disease when treated with NSAIDs. In IBD, infliximab, unlike etanercept, is effective in treating clinical symptoms, inducing and maintaining remission, and mucosal healing. Adalimumab appears to be effective in treating both AS and IBD; however, official approval is pending. Currently, infliximab is the drug of choice for the treatment of patients with active AS associated with IBD.
5%至10%的强直性脊柱炎（AS）病例与炎症性肠病（IBD）相关，后者包括克罗恩病或溃疡性结肠炎。有更大比例的AS患者存在亚临床肠道炎症，可通过内镜检查结果或组织学表现出来。与特发性AS相比，IBD相关AS与HLA - B27的关联较弱，并且有证据表明AS中的肠道炎症与克罗恩病相关的CARD15突变之间存在关联。尽管存在不同的遗传学因素，但免疫病理学表明AS中肠道和关节炎症以及AS和IBD中的肠道炎症存在共同的炎症途径。虽然这一观察结果对于阐明该疾病的病理生理学很有意义，但在没有肠道症状的情况下，不建议对AS患者进行全结肠及回肠结肠镜检查，因为随着时间的推移，只有一小部分有亚临床肠道炎症的AS患者会发展为显性IBD。用非甾体抗炎药（NSAIDs）治疗与IBD相关的AS存在问题，因为担心NSAIDs可能会重新激活IBD。近年来随着抗肿瘤坏死因子（TNF）疗法在AS、其他脊柱关节炎和IBD中的应用取得了重大进展。抗TNF药物对于伴有IBD的AS患者尤为重要，因为这些患者在用NSAIDs治疗时存在基础肠道疾病加重的风险。在IBD中，英夫利昔单抗与依那西普不同，它在治疗临床症状、诱导和维持缓解以及黏膜愈合方面有效。阿达木单抗似乎对治疗AS和IBD都有效；然而，尚未获得官方批准。目前，英夫利昔单抗是治疗伴有IBD的活动性AS患者的首选药物。
