Muscoloskeletal manifestations in inflammatory bowel disease

Muscoloskeletal manifestations are the most common extraintestinal complica tions of inflammatory bowel disease. Wide ranges in prevalence have been re ported, depending on the criteria used to define spondylarthropathy. In 199 1, the European Spondylarthropathy Study Group developed classification cri teria that included previously neglected cases of undifferentiated spondyla rthropathies, which had been ignored in most of the oldest epidemiological studies on inflammatory bowel disease. The spectrum of musculoskeletal mani festations in inflammatory bowel disease patients includes all of the clini cal features of spondylarthropathies: peripheral arthritis, inflammatory sp inal pain, dactylitis, enthesitis (Achilles tendinitis and plantar fasciiti s), buttock pain and anterior chest wall pain. Radiological evidence of sac roiliitis is common but not obligatory. The articular manifestations begin either concomitantly or subsequent to the bowel disease; however, the onset of spinal disease often precedes the diagnosis of inflammatory bowel disea se. The prevalence of the different musculoskeletal manifestations is simil ar in ulcerative colitis and Crohn's disease. Symptoms usually disappear af ter proctocolectomy. The pathogenetic mechanisms that produce the muscolosk eletal manifestations in inflammatory bowel disease are unclear. Several ar guments favour an important role of the intestinal mucosa in the developmen t of spondylarthropathy. The natural history is characterized by periods of flares and remission; therefore, the efficacy of treatment is difficult to establish. Most patients respond to rest, physical therapy and nonsteroida l anti-inflammatory drugs, but these drugs may activate bowel disease. Sulp hasalazine may be recommended in some patients. There is no indication for the systemic use of steroids.