Opportunities for immune modulation in the spondyloarthropathies with special reference to gut inflammation

The spondyloarthropathies (SpA) are a related group of disorders, character ized primarily by spondylitis, pauci-articular arthritis and enthesitis. Th e presence of subclinical gut inflammation in patients with SpA ranges from 25 to 75%, depending upon the type of SpA. Several data suggest that the a ssociation between gut inflammation and synovitis reflects an etiopathogene tic relationship, and that strategies which interfere with the gut inflamma tion may also modulate the synovitis. Here we review some standard as well as experimental drugs used in the treatment of patients with inflammatory b owel disease and discuss what is known about their effect on SpA-related lo comotor manifestations. For the more experimental drugs, such as cytokines, anti-cytokines and anti-adhesion compounds, clinical trials in patients wi th SpA are still very scarce.