Clinical studies indicate an important role for bowel
inflammation in
ankylosing spondylitis and other
spondyloarthropathies whereby two different aspects have to be considered. First, the gut
inflammation is clinically and histologically closely related to
Crohn's disease. Recent data on subclinical immune alterations confirm this relationship and suggest that
spondyloarthropathy is a unique human model for studying early
Crohn's disease. Second, bowel and peripheral joint
inflammation are clinically, histologically and pathogenetically linked. The most important clinical implication of these observations is that targeted
therapies for
Crohn's disease could also be effective for intestinal as well as extra-
intestinal disease manifestations in
spondyloarthropathy, as evidenced by the recent studies on
TNF-alpha blockade. Unravelling the gut-synovium axis in spondyloarthopathy could also contribute to the identification of new therapeutic targets. Finally, assessment of subclinical gut
inflammation by histology, serology and genetics could contribute to the stratification of individual patients in subgroups with an optimal response to specific therapeutic interventions.