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Defining the phenotype, pathogenesis and treatment of Crohn’s disease associated spondyloarthritis

Authors
  • Kumar, Anand1
  • Lukin, Dana1
  • Battat, Robert1
  • Schwartzman, Monica1
  • Mandl, Lisa A.1
  • Scherl, Ellen1
  • Longman, Randy S.1
  • 1 Weill Cornell Medicine,
Type
Published Article
Journal
Journal of Gastroenterology
Publisher
Springer Singapore
Publication Date
May 04, 2020
Volume
55
Issue
7
Pages
667–678
Identifiers
DOI: 10.1007/s00535-020-01692-w
PMID: 32367294
PMCID: PMC7297835
Source
PubMed Central
Keywords
License
Unknown

Abstract

Peripheral and axial spondyloarthritis are the most common extra-intestinal manifestations reported in patients with Crohn’s disease. Despite the frequency of Crohn’s disease associated spondyloarthritis, clinical diagnostic tools are variably applied in these cohorts and further characterization with validated spondyloarthritis disease activity indexes are needed. In addition, the pathogenesis of Crohn’s disease associated spondyloarthritis is not well understood. Evidence of shared genetic, cellular, and microbial mechanisms underlying both Crohn’s disease and spondyloarthritis highlight the potential for a distinct clinicopathologic entity. Existing treatment paradigms for Crohn’s disease associated spondyloarthritis focus on symptom control and management of luminal inflammation. A better understanding of the underlying pathogenic mechanisms in Crohn’s disease associated spondyloarthritis and the link between the gut microbiome and systemic immunity will help pave the way for more targeted and effective therapies. This review highlights recent work that has provided a framework for clinical characterization and pathogenesis of Crohn’s disease associated spondyloarthritis and helps identify critical gaps that will help shape treatment paradigms.

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