The Gut in the Spondyloarthropathies

Journal/Book: Z Rheumatol 1998; 57 Suppl. 1: 4 (H 12). 1998;

Abstract: Dept. of Rheumatology University Hospital Gent The concept of spondyloarthropathy (SpA) gathers together a group of chronic diseases with common clinical biological genetic and therapeutic characteristics. The gut is implied in different diseases included in this disease concept especially enterogenic reactive arthritis and the inflammatory bowel diseases (IBD) Crohn's disease (CD) and ulcerative colitis (UC). It was clear that the gut could play an important role in the pathogenesis of these diseases by permitting exogenous factors to enter the body. This hypothesis was the rationale for investigating the gut in the spondylarthropathies by performing ileocolonoscopies. In first ileocolonoscopic studies of SpA patients histological signs of gut inflammation were seen in about 60 % of these patients mostly presenting no clinical intestinal manifestations. Two types of inflammation can be recognized: an acute type resembling an infectious colitis an a more chronic inflammation resembling CD. Histological signs of gut inflammation were found in all diseases included in the SpA-concept not allways in the same prevalence. Further ileocolonoscopic studies confirmed the strong relationship between gut and joint inflammation. In patients in whom a second ileocolonoscopy was performed remission of the joint inflammation was always connected with a dissappearance of the gut inflammation whereas persistence of locomotor inflammation was mostly associated to the persistence of gut inflammation. The hypothesis was proposed that some patients with a spondyloarthropathy had a form of subclinical CD in which the locomotor inflammation was the only clinical expression. This hypothesis was confirmed in a large prospective long-term study in which ileocolonoscoped patients were revised 5 to 9 years later: about 6 % of SpA patients not presenting an sign of CD at first investigation but demonstrating gut inflammation on biopsy developed full-blown CD. ... le

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