Spondyloarthritis and Gastrointestinal Involvement

F. Atzeni, R. Talotta, I. F. Masala, P. Sarzi-Puttini

Research output: Chapter in Book/Report/Conference proceedingChapter


The term spondyloarthritis (SpA) covers a wide range of diseases that have common features, such as the asymmetric peripheral joint involvement, axial joint inflammation, and enthesitic calcification, including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, undifferentiated SpA, SpA associated with inflammatory bowel disease (IBD), and juvenile-onset SpA. The gastrointestinal tract plays a role in the development of SpAs that are often associated with IBDs such as ulcerative colitis and Crohn's disease; furthermore, cases of asymptomatic colitis have also been described. There is considerable evidence indicating chronic gut inflammation may trigger an autoimmune process that eventually affects musculoskeletal sites. The gastrointestinal tract harbors thousands of commensal flora, and IBD patients have disrupted mucosal integrity, which increases its permeability to dietary and bacterial products that affect the equilibrium of the immune system and reduce peripheral tolerance. Treatment is based on pharmacological measures and physical therapy. According to Assessment of SpondyloArthritis Society guidelines, nonsteroideal antiinflammatory drugs are the first-line drugs for the treatment of SpA. The use of traditional disease-modifying antirheumatic drugs such as methotrexate, sulfasalazine, and leflunomide is confined to the forms of SpA characterized by peripheral involvement. Antitumor necrosis factor drugs are useful in controlling articular (axial involvement) and extraarticular manifestation of SpA.

Original languageEnglish
Title of host publicationHandbook of Systemic Autoimmune Diseases
PublisherElsevier Ltd
Number of pages13
Publication statusPublished - Jan 1 2017

Publication series

NameHandbook of Systemic Autoimmune Diseases
ISSN (Print)1571-5078


  • Ankylosing spondylitis
  • Assessment of SpondyloArthritis Society
  • Gastrointestinal involvement
  • Inflammatory bowel disease
  • Spondyloarthritis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Endocrinology, Diabetes and Metabolism


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