Departments of Medicine, Keck School of Medicine, Los Angeles County + University of Southern California (LAC+USC) Medical Center and University of Southern California, Los Angeles, CA, USA.
Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
Clin Rheumatol. 2022 Aug;41(8):2581-2588. doi: 10.1007/s10067-022-06201-3. Epub 2022 May 11.
Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is clinically closely associated with arthritis. Three major arthritis clinical subtypes have been described, peripheral arthritis type 1 (PeA1), peripheral arthritis type 2 (PeA2), and axial spondyloarthritis (axSpA). While genetic overlaps between IBD and arthritis have been defined, detailed pathophysiology for these three major subtypes of arthritis in patients with IBD has only recently begun to be established. The genetic and molecular mechanisms distinguishing axial and peripheral arthropathies in patients with UC and CD need to be better described. Understanding the pathophysiology for PeA1, PeA2, and axSpA in the settings of both UC and CD is necessary to provide the fundamental biology underlying the clinical phenotypes in IBD arthritis. This has been attempted for CD-associated spondyloarthritis, differentiating this from both CD and axSpA, while observing unique peripheral blood mononuclear cells linking gut inflammation to joint disease. We should know more about the processes by which immune cells are perturbed in these disorders, how they translocate to joints, how they are activated, what other molecules and mediators are involved, and how gut microbes and microbial products damage joints. Information from such studies are needed to elucidate whether distinctions between IBD-related peripheral and axSpA are clinically meaningful. IBD-related peripheral and axSpA studies are needed to elucidate whether distinctions between peripheral and axSpA are clinically meaningful, to better understand immunopathogenesis, and to develop novel targeted therapies.
炎症性肠病（IBD），包括克罗恩病（CD）和溃疡性结肠炎（UC），在临床上与关节炎密切相关。已经描述了三种主要的关节炎临床亚型，外周关节炎 1 型（PeA1）、外周关节炎 2 型（PeA2）和轴性脊柱关节炎（axSpA）。虽然已经确定了 IBD 和关节炎之间的遗传重叠，但最近才开始确定 IBD 患者这三种主要关节炎亚型的详细病理生理学。需要更好地描述 UC 和 CD 患者中区分轴性和外周关节病的遗传和分子机制。了解 UC 和 CD 中 PeA1、PeA2 和 axSpA 的病理生理学对于提供 IBD 关节炎临床表型的基础生物学是必要的。这已经在 CD 相关的脊柱关节炎中进行了尝试，将其与 CD 和 axSpA 区分开来，同时观察到将肠道炎症与关节疾病联系起来的独特外周血单核细胞。我们应该更多地了解这些疾病中免疫细胞受到干扰的过程，它们如何转移到关节，如何被激活，涉及哪些其他分子和介质，以及肠道微生物和微生物产物如何损害关节。需要这些研究的信息来阐明 IBD 相关的外周和 axSpA 之间的区别在临床上是否有意义。需要进行 IBD 相关的外周和 axSpA 研究，以阐明外周和 axSpA 之间的区别在临床上是否有意义，以更好地了解免疫发病机制，并开发新的靶向治疗方法。
