The transition of acute to chronic bowel inflammation in spondyloarthritis

Nat Rev Rheumatol. 2012 Apr 17;8(5):288-95. doi: 10.1038/nrrheum.2012.42.


That gut and joint inflammation are linked in spondyloarthritis (SpA) has been recognized for almost three decades. Intriguingly, microscopic gut inflammation, which occurs frequently in patients with SpA, is an important risk factor for clinically overt Crohn's disease and ankylosing spondylitis. This Review describes current insights into the underlying mechanisms that lead to chronic gut inflammation in patients with SpA. We propose that the development of chronic bowel inflammation in these individuals occurs through a transition phase, in which inflammation evolves from an acute into a chronic state. Our transition model implies that different cell types are involved at different stages during disease progression, with stromal cells having an important role in chronicity. In addition, deficient regulatory feedback mechanisms or genetically determined alterations in antigen presentation, endoplasmic reticulum stress, autophagy or cytokine signaling might also favor a transition from self-limiting acute inflammation to chronic inflammation. We anticipate that this transition phase might be an important window for therapeutic intervention.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Acute Disease
  • Adult
  • Age Distribution
  • Age of Onset
  • Aged
  • Chronic Disease
  • Comorbidity
  • Crohn Disease / diagnosis
  • Crohn Disease / epidemiology
  • Disease Progression*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Inflammatory Bowel Diseases / diagnosis*
  • Inflammatory Bowel Diseases / epidemiology*
  • Male
  • Middle Aged
  • Risk Factors
  • Severity of Illness Index
  • Sex Distribution
  • Spondylarthritis / diagnosis*
  • Spondylarthritis / epidemiology*
  • Spondylitis, Ankylosing / diagnosis
  • Spondylitis, Ankylosing / epidemiology
  • Time Factors