THE EVOLUTION OF SPONDYLOARTHROPATHIES IN RELATION TO GUT HISTOLOGY .3. RELATION BETWEEN GUT AND JOINT

Objective. To study prospectively the clinical evolution of different forms of spondyloarthropathy (SpA) in relation to the evolution of gut histology in consecutive ileocolonoscopic biopsy specimens. Methods. Ileocolonoscopy was performed in 49 patients with SpA (34 men, 15 wome n). They also underwent clinical, laboratory, and radiological examina tions. Two to 9 years later, a 2nd and sometimes a 3rd or 4th ileocolo noscopy was performed, and the other examinations were repeated. Resul ts. At first ileocolonoscopy, 34 patients (69%) showed inflammatory gu t lesions. At the 2nd ileocolonoscopy, 16 patients (32%) were in clini cal remission; none were found to have inflammatory gut lesions. Of th e 33 patients with persistent locomotor inflammation, 14 had persisten t inflammatory gut lesions, predominantly the chronic type. Of these 1 4 patients, 6 had developed inflammatory bowel disease (IBD). None of the 15 patients with an initially normal gut histology had gut inflamm ation at 2nd examination. Of the 9 with initially acute lesions, 3 dev eloped chronic lesions (1 Crohn's disease). Initial chronic lesions in 25 patients persisted in 9, of whom 5 had developed IBD. Seven of the 19 patients with non-SpA ankylosing spondylitis (non-AS-SpA) develope d ankylosing spondylitis (AS); all had initially presented inflammator y gut lesions, which persisted at 2nd examination. In the 11 patients with more than 2 consecutive ileocolonoscopies, clinical remission was always associated with normal gut histology, and flares of the joint disease were related temporally to the reappearance of gut inflammatio n. Conclusion. This study demonstrates the close relationship between gut and locomotor inflammation in SpA. Clinical remission was always a ssociated with normal gut histology, whereas active locomotor inflamma tion was usually associated with the presence of gut inflammation. Abs ence of gut inflammation in the SpA is a good prognostic indicator, si nce gut inflammation or IBD never develops in these patients. Evolutio n of non-AS-SpA to full blown AS or of uncomplicated SpA to a farm of IBD was always associated with gut inflammation at disease onset.