Wang CR, Tsai HW. Seronegative spondyloarthropathy-associated inflammatory bowel disease. World J Gastroenterol 2023; 29(3): 450-468 [PMID: 36688014 DOI: 10.3748/wjg.v29.i3.450]
Corresponding Author of This Article
Chrong-Reen Wang, MD, PhD, Full Professor, Internal Medicine, National Cheng Kung University Hospital, No. 138 Sheng-Li Road, Tainan 70403, Taiwan. wangcr@mail.ncku.edu.tw
Research Domain of This Article
Rheumatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 21, 2023; 29(3): 450-468 Published online Jan 21, 2023. doi: 10.3748/wjg.v29.i3.450
Table 1 Demographic, clinical, laboratory, therapeutic, and prognostic profiles in five seronegative spondyloarthropathy subgroups
Category
AS
PsA
ReA
EnA
JSpA
Demographic
Sex, M:F
3:1
1:1
5-10:1
1:1
ERA 3:1, JPsA 1:2
Age, yr
20-40
35-45
Any
20-40
< 16
Laboratory
HLA-B27
> 90%
Axial 50%-70%
60%-80%
Axial 50%-70%
ERA 40%-70%
Peripheral 20%
Peripheral 20%
JPsA 10%
Clinical
Affected joints
Spine, sacroiliitis
Any area
Peripheral, sacroiliitis
Peripheral
Peripheral, sacroiliitis
Peripheral
30%, lower
Common, upper
Common, lower
Common, lower
Common, lower
Sacroiliitis
100%
50%
30% in urogenital
20%
40%-60% in ERA
Dactylitis
Uncommon
Common
Common
Uncommon
20% in JPsA
Enthesitis
Common
Common
Common
Uncommon
Uncommon
EAM common
Intestine, skin, uveitis
Intestine, skin, uveitis
Skin, uveitis
Intestine, skin, uveitis
Intestine, skin, uveitis
Treatment
Spinal physical therapy, NSAIDs/cDMARDs for peripheral SpA, biologics, JAKi
NSAIDs, avoid CS, cDMARDs for peripheral SpA, biologics, JAKi, PDE4i
NSAIDs, antibiotics for chlamydia-induced ReA, cDMARDs for peripheral SpA
Coxibs/cDMARDs for peripheral SpA, biologics, JAKi
Spinal physical therapy, NSAIDs/cDMARDs for peripheral SpA, biologics
Prognosis
Life-threatening EAMs with heart, intestine or neurological involvement
Comorbidities associated with more severe disease activity
Usually a self-limited disease
Rarely grave EnA in controlled intestinal activity
More spinal deformity and THR as compared with adult SpA or other JIA subtypes
Table 2 Demographic, clinical, laboratory, therapeutic, and prognostic profiles in two main types of inflammatory bowel disease
Category
Ulcerative colitis
Crohn’s disease
Demographic
Sex, M:F
1:1
1:1
Age at onset in yr
30-50
10-40
Laboratory
ANCA
Common
Rare
ASCA
Rare
Common
Clinical
Origin/Location
Rectum/colon, rectum
Terminal ileum/any part
Distribution
Continuous
Skip lesions
Pathology
Inflamed thickness
Mucosa, submucosa
Transmural
Crypt abscess
Common
Uncommon
Granuloma
Rare
Common
Fissure
Uncommon
Common
Fibrosis
Rare
Common
Treatment
ASA, CS, IS, biologics, JAKi, S1PR modulator, surgery for refractory medical disease or malignancy
CS, IS, biologics, surgery for refractory medical disease, complication or malignancy
Prognosis
Complete remission in most patients, low surgical requirement
Prolonged remission in about 20% of patients, 10-yr surgical resection risk near 50%
Table 3 Inflammatory bowel disease manifestation in ankylosing spondylitis patients receiving approved tumor necrosis factor inhibitor or Janus kinase inhibitor therapy published in the English literature
Table 4 Demographic, clinical, laboratory, medication, course, and outcome profiles in 4 ankylosing spondylitis-associated inflammatory bowel disease patients from 2017 January to 2021 December[30]
Early in IBD disease course, acute and self-limiting (mostly under 10 wk)
Arthritis for months, episodic exacerbation for yr
Disease characters
IBD activity
Parallel with activity
Independent of activity
Other EIM
EN, uveitis
Uveitis
HLA association
HLA-B27, B35, DR*0103
HLA-B44
Treatment
Control of IBD activity, coxibs, CS, cDMARDs (SAZ 1st choice), TNF mAbs for refractory cases, JAKi for anti-TNF failure
Coxibs, CS, cDMARDs (SAZ 1st choice), TNF mAbs for refractory cases, JAKi for anti-TNF failure
Table 6 Generic names and currently approved indications of biologics and small molecules from the United States Food and Drug Administration for ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis, and inflammatory bowel disease