Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medicine, 413 E 69th Street, 7th Floor, New York, NY, 10021, USA.
Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA.
J Gastroenterol. 2020 Jul;55(7):667-678. doi: 10.1007/s00535-020-01692-w. Epub 2020 May 4.
Peripheral and axial spondyloarthritis are the most common extra-intestinal manifestations reported in patients with Crohn's disease. Despite the frequency of Crohn's disease associated spondyloarthritis, clinical diagnostic tools are variably applied in these cohorts and further characterization with validated spondyloarthritis disease activity indexes are needed. In addition, the pathogenesis of Crohn's disease associated spondyloarthritis is not well understood. Evidence of shared genetic, cellular, and microbial mechanisms underlying both Crohn's disease and spondyloarthritis highlight the potential for a distinct clinicopathologic entity. Existing treatment paradigms for Crohn's disease associated spondyloarthritis focus on symptom control and management of luminal inflammation. A better understanding of the underlying pathogenic mechanisms in Crohn's disease associated spondyloarthritis and the link between the gut microbiome and systemic immunity will help pave the way for more targeted and effective therapies. This review highlights recent work that has provided a framework for clinical characterization and pathogenesis of Crohn's disease associated spondyloarthritis and helps identify critical gaps that will help shape treatment paradigms.
外周和中轴型脊柱关节炎是克罗恩病患者最常见的肠道外表现。尽管克罗恩病相关的脊柱关节炎较为常见，但在这些队列中临床诊断工具的应用各不相同，需要使用经过验证的脊柱关节炎疾病活动指数进行进一步的特征描述。此外，克罗恩病相关脊柱关节炎的发病机制尚不清楚。在克罗恩病和脊柱关节炎的发病机制中存在共同的遗传、细胞和微生物机制的证据，突出了存在独特的临床病理实体的可能性。现有的克罗恩病相关脊柱关节炎治疗方案侧重于症状控制和腔道炎症的管理。更好地了解克罗恩病相关脊柱关节炎的潜在发病机制以及肠道微生物组和全身免疫之间的联系，将有助于为更有针对性和有效的治疗方法铺平道路。本综述强调了最近的工作，这些工作为克罗恩病相关脊柱关节炎的临床特征描述和发病机制提供了框架，并有助于确定关键的空白领域，从而有助于塑造治疗模式。
