Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy.
Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy.
Nat Rev Rheumatol. 2023 Aug;19(8):503-518. doi: 10.1038/s41584-023-00984-8. Epub 2023 Jun 29.
Spondyloarthritis (SpA) encompasses a heterogeneous group of chronic inflammatory diseases that can affect both axial and peripheral joints, tendons and entheses. Among the extra-articular manifestations, inflammatory bowel disease (IBD) is associated with considerable morbidity and effects on quality of life. In everyday clinical practice, treatment of these conditions requires a close collaboration between gastroenterologists and rheumatologists to enable early detection of joint and intestinal manifestations during follow-up and to choose the most effective therapeutic regimen, implementing precision medicine for each patient's subtype of SpA and IBD. The biggest issue in this field is the dearth of drugs that are approved for both diseases, as only TNF inhibitors are currently approved for the treatment of full-spectrum SpA-IBD. Janus tyrosine kinase inhibitors are among the most promising drugs for the treatment of peripheral and axial SpA, as well as for intestinal manifestations. Other therapies such as inhibitors of IL-23 and IL-17, phosphodiesterase 4 inhibitor, α4β7 integrin blockers and faecal microbiota transplantation seem to only be able to control some disease domains, or require further studies. Given the growing interest in the development of novel drugs to treat both conditions, it is important to understand the current state of the art and the unmet needs in the management of SpA-IBD.
脊柱关节炎（SpA）包括一组异质性的慢性炎症性疾病，可影响轴性和外周关节、肌腱和附着点。在关节外表现中，炎症性肠病（IBD）与相当大的发病率和生活质量影响相关。在日常临床实践中，这些疾病的治疗需要胃肠病学家和风湿病学家之间的密切合作，以便在随访期间及早发现关节和肠道表现，并为每个患者的 SpA 和 IBD 亚型选择最有效的治疗方案，实施针对每个患者的精准医学。该领域最大的问题是缺乏同时批准用于这两种疾病的药物，因为目前只有 TNF 抑制剂被批准用于治疗全谱 SpA-IBD。Janus 酪氨酸激酶抑制剂是治疗外周和轴向 SpA 以及肠道表现的最有前途的药物之一。其他疗法，如 IL-23 和 IL-17 抑制剂、磷酸二酯酶 4 抑制剂、α4β7 整合素阻滞剂和粪便微生物群移植，似乎只能控制某些疾病领域，或需要进一步研究。鉴于人们对开发治疗这两种疾病的新药越来越感兴趣，了解 SpA-IBD 管理的最新技术和未满足的需求非常重要。
