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29-Sep-2000
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Arch Hellen Med, 17(1), January-February 2000, 18-25
REVIEW
Pathogenesis and therapy of rheumatic manifestations
of inflammatory bowel disease
I.A. MOUZAS,1 H.D. KRITIKOS2
1Department
of Gastroenterology,
2Department of Rheumatology, Medical School, University of Crete,
Greece
Rheumatic manifestations of inflammatory bowel disease (IBD, i.e. ulcerative colitis and Crohn’s disease) are common. Understanding the pathogenesis of these extraintestinal manifestations of IBD is important in developing and selecting therapeutic strategies. Immunological mechanisms involved in the triggering and perpetuation of the inflammation in IBD are also involved in the pathogenesis of the rheumatic manifestations. Sensitization is observed of macrophages and T-lymphocytes in IBD related arthropathies and knowledge of the pathogenesis will be further expanded with immunological studies of the synovium. The therapy of articular involvement in IBD consists of treating the underlying intestinal disease and relieving pain, reducing inflammation and preventing deformities and ankylosis using drugs and physiotherapy. Simple analgesics and non-steroid anti-inflammatory drugs (NSAIDs) offer quick symptom relief, but have to be prescribed with caution, owing to the possibility of causing IBD relapse. In cases where symptoms persist corticosteroids may be used by either topical or systematic administration. Second-line drugs, i.e. sulphasalazine and methotrexate, can reverse the natural course of the articular involvement. Sulphasalazine has proved effective in peripheral arthritis of IBD, but with a delay in action of about 2–3 months after the beginning of treatment. Concerning methotrexate, there are several encouraging reports of therapeutic results. Antibodies against cytokines, especially the chimeric anti-TNF-α, are promising new drugs. Prevention and rehabilitation in patients with ankylosing spondylitis are essential steps towards the achievement of a better quality of life. Physiotherapy, regular exercise and adopting a favorable way of life are of paramount importance.
Key words: Crohn's disease, Pathogenesis, Rheumatic manifestations, Therapy, Ulcerative colitis.
