Pharmacological management of spondyloarthritis associated with inflammatory bowel disease: a systematic review of efficacy, safety, and emerging therapies
Notice bibliographique
Résumé
BACKGROUND: Spondyloarthritis (SpA) is a prevalent extraintestinal symptom of inflammatory bowel disease (IBD), impacting up to 20% of patients and considerably contributing to the disease burden. The coexistence of inflammatory bowel disease and spondyloarthritis poses therapeutic problems due to the necessity for simultaneous management of intestinal and musculoskeletal inflammation. OBJECTIVE: To conduct a comprehensive review and synthesis of the current evidence regarding pharmacological treatments for IBD-associated SpA. This review will assess the efficacy of these treatments on both gut and joint symptoms, as well as their safety profiles and therapeutic positioning. METHODS: A thorough search of PubMed, Scopus, and the Cochrane Library was performed till May 2025. Studies were included if they focused on adult patients with concurrent IBD and SpA, and assessed pharmacological treatments. Data extraction adhered to PRISMA criteria. The risk of bias was evaluated via the Newcastle–Ottawa Scale, SANRA, and qualitative assessment for expert consensus. RESULTS: Thirteen studies were included, comprising observational cohorts, narrative reviews, and expert consensus guidelines. Tumour necrosis factor inhibitors (TNFi), including infliximab and adalimumab, consistently demonstrated dual efficacy in improving gastrointestinal and musculoskeletal outcomes, notably reducing disease activity indices such as BASDAI, ASDAS, and CDAI. Conventional synthetic DMARDs, such as methotrexate and sulfasalazine, provided modest benefit in peripheral arthritis but lacked efficacy for axial SpA and intestinal inflammation. Emerging therapies—particularly ustekinumab (IL-12/23 inhibitor) and vedolizumab (gut-selective anti-integrin)—were considered valuable options in TNFi-refractory patients. However, their impact on axial symptoms remains uncertain, and guidelines advise caution in such phenotypes. Janus kinase inhibitors (e.g., tofacitinib, upadacitinib) have shown promise in both ulcerative colitis and axial SpA, but require further validation in IBD-SpA overlap populations. IL-23 blockers and TYK2 inhibitors are under investigation, particularly for gut-dominant disease, though evidence in SpA is limited. IL-17 inhibitors, while effective in SpA, are generally contraindicated in IBD due to risk of intestinal flares. Combination strategies, including dual-biologic therapies or biologic–DMARD regimens, are increasingly explored for complex or refractory cases, with observational data suggesting clinical benefit and acceptable safety under close monitoring. CONCLUSION: TNFi remains to be the cornerstone treatment for IBD-associated SpA. Biologic alternatives like ustekinumab and vedolizumab provide targeted options for specific individuals; nevertheless, additional data is required regarding axial involvement. An individualised, multidisciplinary therapy approach is crucial. Future research should focus on head-to-head trials, long-term safety assessments, and prediction biomarkers to enhance personalised treatment in this dual disease scenario. PROSPERO REGISTRATION ID: 1,084,370.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,006 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».