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Occult spondyloarthritis in inflammatory bowel disease

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Abstract

Spondyloarthritis (SpA) is a frequent extra-intestinal manifestation in patients with inflammatory bowel disease (IBD), although its real diffusion is commonly considered underestimated. Abnormalities in the microbioma and genetic predisposition have been implicated in the link between bowel and joint inflammation. Otherwise, up to date, pathogenetic mechanisms are still largely unknown and the exact influence of the bowel activity on rheumatic manifestations is not clearly explained. Due to evidence-based results of clinical studies, the interest on clinically asymptomatic SpA in IBD patients increased in the last few years. Actually, occult enthesitis and sacroiliitis are discovered in high percentages of IBD patients by different imaging techniques, mainly enthesis ultrasound (US) and sacroiliac joint X-ray examinations. Several diagnostic approaches and biomarkers have been proposed in an attempt to correctly classify and diagnose clinically occult joint manifestations and to define clusters of risk for patient screening, although definitive results are still lacking. The correct recognition of occult SpA in IBD requires an integrated multidisciplinary approach in order to identify common diagnostic and therapeutic strategies. The use of inexpensive and rapid imaging techniques, such as US and X-ray, should be routinely included in daily clinical practice and trials to correctly evaluate occult SpA, thus preventing future disability and worsening of quality of life in IBD patients.

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This article was not supported by research funding. All authors do not have any potential financial conflict of interest.

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None.

Authors’ contribution

All authors had a substantial role in this study and have read and agreed to the content of the manuscript before submission. Bandinelli F and Manetti M initiated this review, searched the literature, and contributed largely to the writing and drafting of the manuscript; Ibba-Manneschi L drafted the article and revised it critically for important intellectual content. The authors thank Dr. Anna Franca Milia for providing histological images of entheses in the HLA-B27 transgenic rat model. No other contribution or writing assistance that does not meet the criteria for authorship is included in this study.

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Authors and Affiliations

  1. Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy

    Francesca Bandinelli, Mirko Manetti & Lidia Ibba-Manneschi

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  1. Francesca Bandinelli
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  2. Mirko Manetti
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  3. Lidia Ibba-Manneschi
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Correspondence to Francesca Bandinelli.

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Bandinelli, F., Manetti, M. & Ibba-Manneschi, L. Occult spondyloarthritis in inflammatory bowel disease. Clin Rheumatol 35, 281–289 (2016). https://doi.org/10.1007/s10067-015-3074-z

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  • DOI: https://doi.org/10.1007/s10067-015-3074-z

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