Background Enteropathic spondyloarthritis (ES) are characterized by the coexistence of articular-enthesis inflammation with gastrointestinal inflammation, represented by inflammatory bowel diseases (IBD). Because of the coexistence of gut and articular inflammation, the therapeutic strategies should take into account both the IBD and the SpA clinical manifestations and drugs active on both gastrointestinal and articular systems should be preferred (1).
Objectives A cohort of 51 pts affected by enteropathic spondyloarthritis (ES) was evaluated for both articular and intestinal disease activity in the outpatient clinics and in the clinical ward of the gastroenterology and internal medicine departments at baseline, and after 3 and 6 months of treatment with synthetic DMARDs or with a biological drug (adalimumab, ADA).
Methods Since January 2014 to January 2015, enteropathic spondyloarthritis (ES) had been diagnosed in 51 pts affected by IBD, 32 Crohn's disease (67%) and 19 ulcerative colitis (33%): the 22 pts with peripheral arthritis were treated with methotrexate (n.12, 55%) or salazopyrine (n.10, 45%), and the 23 pts affected by axial SpA with ADA. At baseline, IBD resulted active in 31 (61%) pts. At baseline and follow up, the following features were evaluated: a) articular and gastrointestinal symptoms and activity; b) patient reported outcomes of the quality of life (Fig.1).
Results All the drugs employed in this study resulted safe and well tolerated, and no side effects were observed. 48 pts were compliant to the treatment at 6 months and 3 pts dropped from the study (2 for inefficacy of the therapy, 1 for pregnancy). At baseline, articular and IBD disease activity resulted higher in ES pts with axial involvement than in those with peripheral arthritis (Fig.1). After 6 months of treatment, the articular disease activity (Fig.1A) and the quality of life (Fig.1B) were significantly improved in pts treated with ADA, but not in those treated with methotrexate or salazopyrine. Most importantly, only ADA was effective in reducing both articular and intestinal inflammation (Fig.1C), achieving a prolonged clinical remission of IBD in 20 (87%) of the pts
Conclusions The choice of the optimal therapeutic strategy in ES should take into account drugs that are effective in the control of articular and intestinal symptoms, likely inducing the disease remission of both SpA and IBD (1). In our work we confirm that the treatment with ADA, and not with methotrexate or salazopyrine, led to a stable remission of both articular and intestinal inflammation, and a consistent improvement of the quality of life.
Braun J. et al. Ann Rheum Dis 2010, 70:869-904.
Disclosure of Interest None declared