Pharmacological management of spondyloarthritis associated with inflammatory bowel disease: a systematic review of efficacy, safety, and emerging therapies
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.007 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".