Management of Arthritis Associated with Inflammatory Bowel Disease (IBD): A Systematic Review of Conventional and Targeted Therapies

Vollständiger Abstract

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Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, is a chronic inflammatory disorder of the gastrointestinal tract associated with significant extraintestinal manifestations. Arthritis is the most frequent extraintestinal manifestation, with an overall prevalence of 17–39%, and is classified as a subtype of spondyloarthritis involving axial and/or peripheral joints. Peripheral arthritis is generally non-erosive, with the oligoarticular variant correlating with intestinal disease activity, whereas axial arthritis—including sacroiliitis and ankylosing spondylitis—tends to progress independently of bowel disease activity. This narrative review aims to provide a comprehensive overview of IBD-associated arthritis, covering its definition, epidemiology, pathogenesis, clinical manifestations, diagnosis, and management. Pathogenesis involves three interconnected mechanisms: extension of intestinal immune responses, gut microbiota dysregulation through Th17 pathway activation, and genetic predisposition mediated by HLA-B27 and NOD2/CARD15. Diagnosis relies on ASAS clinical criteria, with MRI as the preferred modality for early detection of axial involvement. Management requires an integrated approach; TNF-α inhibitors serve as first-line therapy in active disease, while JAK inhibitors, ustekinumab, and vedolizumab represent promising novel therapeutic options. Multidisciplinary collaboration between gastroenterologists and rheumatologists is essential to optimize long-term clinical outcomes.