Joint involvement in inflammatory bowel disease: managing inflammation outside the digestive system

Abstract

Joint inflammation is present in approximately 30% of patients with inflammatory bowel disease. Peripheral arthritis can frequently be controlled by an optimal treatment of the gut inflammation in association with short-term use of NSAIDs. Recurrent inflammation requires the use of sulfasalazine. More therapy-resistant forms and axial arthropathy can be treated with anti-TNF drugs, predominantly infliximab and adalimumab. An intensified multidisciplinary approach in research and in the clinic may help to unravel the question of why common etiopathogenic mechanisms ultimately lead to different disease phenotypes. Animal models may help to identify the most promising therapeutic strategies including in the near future modulation of adhesion molecules, costimulatory molecules and the Th17 pathway.