https://doi.org/10.4081/reumatismo.2024.1770

Inflammatory bowel diseases and spondyloarthritis: a focus on female patients

Vol. 76 No. 3 (2024)
Published: 11 September 2024
Arthritis, crohn disease, ulcerative colitis, females
Abstract Views: 745
PDF: 263
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

C. Caranfil
Department of Surgery, Oncology, and Gastroenterology, University of Padova; Gastroenterology Unit, Azienda Ospedale - Università Padova, Italy.
G. Lorenzon
Department of Surgery, Oncology, and Gastroenterology, University of Padova, Italy.
B. Barberio
Gastroenterology Unit, Azienda Ospedale - Università Padova, Italy.
R. Ramonda
Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy.
E.V. Savarino
Department of Surgery, Oncology, and Gastroenterology, University of Padova; Gastroenterology Unit, Azienda Ospedale - Università Padova, Italy.
F. Zingone
fabiana.zingone@unipd.it
https://orcid.org/0000-0003-1133-1502
Department of Surgery, Oncology, and Gastroenterology, University of Padova; Gastroenterology Unit, Azienda Ospedale - Università Padova, Italy.

Objective. Ulcerative colitis and Crohn’s disease are chronic inflammatory diseases and represent the two most important types of inflammatory bowel diseases (IBD), while spondyloarthritis (SpA) comprises a heterogeneous group of systemic inflammatory chronic rheumatic diseases, including peripheral SpA and axial SpA. Joint manifestations are the most commonly observed extraintestinal manifestations, and they can precede or not the diagnosis of IBD. Notably, in women, misdiagnoses of IBD as irritable bowel syndrome and SpA as fibromyalgia are common, leading to delayed diagnoses, increased disease burden, and poorer prognoses. This narrative review emphasizes the critical role of diagnostic tools in facilitating early referrals of IBD patients with suspected SpA and vice versa to rheumatologists and gastroenterologists, respectively. Special attention is given to the multidisciplinary approach for more effective management of these conditions, particularly in female patients.

Methods. In this narrative review, we critically evaluated the literature on this topic, focusing on papers written in English that address female issues in IBD and SpA.

Results. IBD and SpA are chronic inflammatory disorders often occurring in the same patients. Female patients are often misdiagnosed, and this delay in diagnosis is associated with a higher disease burden and a poorer prognosis.

Conclusions. A multidisciplinary approach is needed to enable early referral between gastroenterologists and rheumatologists, as this means a better prognosis for patients with a reduction in the economic and social burden associated with IBD and SpA.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Gros B, Kaplan GG. Ulcerative colitis in adults: a review. JAMA 2023; 330: 951-65. DOI: https://doi.org/10.1001/jama.2023.15389
Roda G, Chien Ng S, Kotze PG, Argollo M, Panaccione R, Spinelli A, et al. Crohn’s disease. Nat Rev Dis Primers 2020; 6: 22. DOI: https://doi.org/10.1038/s41572-020-0156-2
Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet 2017; 390: 73-84. DOI: https://doi.org/10.1016/S0140-6736(16)31591-4
Cantoro L, Di Sabatino A, Papi C, Margagnoni G, Ardizzone S, Giuffrida P, et al. The time course of diagnostic delay in inflammatory bowel disease over the last sixty years: an Italian multicentre study. J Crohns Colitis 2017; 11: 975-80. DOI: https://doi.org/10.1093/ecco-jcc/jjx041
Cantoro L, Monterubbianesi R, Falasco G, Camastra C, Pantanella P, Allocca M, et al. The earlier you find, the better you treat: red flags for early diagnosis of inflammatory bowel disease. Diagnostics 2023; 13: 3183. DOI: https://doi.org/10.3390/diagnostics13203183
Roisinblit KC. Irritable bowel syndrome in women. J Midwifery Womens Health 2013; 58: 15-24. DOI: https://doi.org/10.1111/j.1542-2011.2012.00200.x
Huang KY, Wang FY, Lv M, Ma XX, Tang XD, Lv L. Irritable bowel syndrome: epidemiology, overlap disorders, pathophysiology and treatment. World J Gastroenterol 2023; 29: 4120-35. DOI: https://doi.org/10.3748/wjg.v29.i26.4120
Rustøen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C. Age and the experience of chronic pain. Clin J Pain 2005; 21: 513-23. DOI: https://doi.org/10.1097/01.ajp.0000146217.31780.ef
Aloush V, Ablin JN, Reitblat T, Caspi D, Elkayam O. Fibromyalgia in women with ankylosing spondylitis. Rheumatol Int 2007; 27: 865-8. DOI: https://doi.org/10.1007/s00296-007-0344-3
Barnett R, Gaffney K, Sengupta R. Diagnostic delay in axial spondylarthritis: a lost battle?. Best Pract Res Clin Rheumatol 2023; 37: 101870 DOI: https://doi.org/10.1016/j.berh.2023.101870
Chimenti MS, Alten R, D’Agostino MA, Gremese E, Kiltz U, Lubrano E, et al. Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: Addressing the unmet needs of female patients. RMD Open 2021; 7: e001681 DOI: https://doi.org/10.1136/rmdopen-2021-001681
Wendling D, Hecquet S, Fogel O, Letarouilly JG, Verhoeven F, Pham T, et al. 2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis. Joint Bone Spine 2022; 89: 105344 DOI: https://doi.org/10.1016/j.jbspin.2022.105344
Mak WY, Zhao M, Ng SC, Burisch J. The epidemiology of inflammatory bowel disease: east meets west. J Gastroenterol Hepatol 2020; 35: 380-9. DOI: https://doi.org/10.1111/jgh.14872
Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol 2015; 12: 720-7. DOI: https://doi.org/10.1038/nrgastro.2015.150
Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 2021; 18: 56-66. DOI: https://doi.org/10.1038/s41575-020-00360-x
Alatab S, Sepanlou SG, Ikuta K, Vahedi H, Bisignano C, Safiri S, et al. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5: 17-30. DOI: https://doi.org/10.1016/S2468-1253(19)30333-4
Zarco P, González CM, Rodríguez De La Serna A, Peiró E, Mateo I, Linares L, et al. Extra-articular disease in patients with spondyloarthritis. Baseline characteristics of the spondyloarthritis cohort of the AQUILES study. Reumatol Clin 2015; 11: 83-9. DOI: https://doi.org/10.1016/j.reumae.2014.11.001
Hedin CRH, Vavricka SR, Stagg AJ, Schoepfer A, Raine T, Puig L, et al. The pathogenesis of extraintestinal manifestations: implications for IBD research, diagnosis, and therapy. J Crohns Colitis 2019; 13: 541-54. DOI: https://doi.org/10.1093/ecco-jcc/jjy191
Fumery M, Singh S, Dulai PS, Gower-Rousseau C, Peyrin-Biroulet L, Sandborn WJ. Natural history of adult ulcerative colitis in population-based cohorts: a systematic review. Clin Gastroenterol Hepatol 2018; 16: 343-56.e3. DOI: https://doi.org/10.1016/j.cgh.2017.06.016
Vavricka SR, Rogler G, Gantenbein C, Spoerri M, Vavricka MP, Navarini AA, et al. Chronological order of appearance of extraintestinal manifestations relative to the time of IBD diagnosis in the Swiss Inflammatory Bowel Disease Cohort. Inflamm Bowel Dis 2015; 21: 1794-800. DOI: https://doi.org/10.1097/MIB.0000000000000429
Varkas G, Ribbens C, Louis E, Van den Bosch F, Lories R, Vermeire S, et al. Expert consensus: practical algorithms for management of inflammatory bowel disease patients presenting with back pain or peripheral arthropathies. Aliment Pharmacol Ther 2019; 50: 1204-13. DOI: https://doi.org/10.1111/apt.15519
Navarro-Compán V, Sepriano A, El-Zorkany B, van der Heijde D. Axial spondyloarthritis. Ann Rheum Dis 2021; 80: 1511-21. DOI: https://doi.org/10.1136/annrheumdis-2021-221035
Lorenzin M, Cozzi G, Scagnellato L, Ortolan A, Vio S, Striani G, et al. Relationship between sex and clinical and imaging features of early axial spondyloarthritis: results from a 48 month follow-up (Italian arm of the SPondyloArthritis Caught Early (SPACE) study). Scand J Rheumatol 2023; 52: 519-29. DOI: https://doi.org/10.1080/03009742.2023.2169990
Goodman WA, Erkkila IP, Pizarro TT. Sex matters: impact on pathogenesis, presentation and treatment of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 2020; 17: 740-54. DOI: https://doi.org/10.1038/s41575-020-0354-0
Algaba A, Guerra I, Ricart E, Iglesias E, Mañosa M, Gisbert JP, et al. Extraintestinal manifestations in patients with inflammatory bowel disease: study based on the ENEIDA registry. Dig Dis Sci 2021; 66: 2014-23. DOI: https://doi.org/10.1007/s10620-020-06424-x
Peluso R, Di Minno MND, Iervolino S, Manguso F, Tramontano G, Ambrosino P, et al. Enteropathic spondyloarthritis: from diagnosis to treatment. Clin Dev Immunol 2013; 2013: 631408. DOI: https://doi.org/10.1155/2013/631408
Zioga N, Kogias D, Lampropoulou V, Kafalis N, Papagoras C. Inflammatory bowel disease-related spondyloarthritis: the last unexplored territory of rheumatology. Mediterr J Rheumatol 2022; 33: 126-36. DOI: https://doi.org/10.31138/mjr.33.1.126
Carubbi F, Alunno A, Viscido A, Baraliakos X, Mariani FM, Di Ruscio E, et al. SpA plus IBD or IBD plus SpA: does commutative property apply?. Autoimmun Rev 2023; 22: 103443. DOI: https://doi.org/10.1016/j.autrev.2023.103443
Harbord M, Annese V, Vavricka SR, Allez M, Acosta MB de, Boberg KM, et al. The first european evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease. J Crohns Colitis 2016; 10: 239-54. DOI: https://doi.org/10.1093/ecco-jcc/jjv213
Ossum AM, Palm Ø, Lunder AK, Cvancarova M, Banitalebi H, Negård A, et al. Ankylosing spondylitis and axial spondyloarthritis in patients with long-term inflammatory bowel disease: results from 20 years of follow-up in the IBSEN study. J Crohns Colitis 2018; 12: 96-104. DOI: https://doi.org/10.1093/ecco-jcc/jjx126
Ono K, Kishimoto M, Deshpande GA, Fukui S, Kawaai S, Sawada H, et al. Clinical characteristics of patients with spondyloarthritis and inflammatory bowel disease versus inflammatory bowel disease-related arthritis. Rheumatol Int 2022; 42: 1751-66. DOI: https://doi.org/10.1007/s00296-022-05117-0
Maguire S, Wilson F, Gallagher P, O’Shea FD. Worse scores but similar patterns of disease activity: interpreting outcomes in women with axial spondyloarthropathy. Scand J Rheumatol 2023; 52: 142-9. DOI: https://doi.org/10.1080/03009742.2021.2007609
Wendling D, Guillot X, Prati C, Miceli-Richard C, Molto A, Lories R, et al. Effect of gut involvement in patients with high probability of early spondyloarthritis: data from the DESIR cohort. J Rheumatol 2020; 47: 349-53. DOI: https://doi.org/10.3899/jrheum.181326
Felice C, Dal Buono A, Gabbiadini R, Rattazzi M, Armuzzi A. Cytokines in spondyloarthritis and inflammatory bowel diseases: from pathogenesis to therapeutic implications. Int J Mol Sci 2023; 24: 3957. DOI: https://doi.org/10.3390/ijms24043957
Shen YH, Zhu H, Zhou L, Zheng YQ, Zhang Z, Xie Y, et al. In inflammatory bowel disease and extraintestinal manifestations: what role does microbiome play?. Engineered Regeneration 2023; 4: 337-48. DOI: https://doi.org/10.1016/j.engreg.2023.04.005
Salmi M, Jalkanen S. Human leukocyte subpopulations from inflamed gut bind to joint vasculature using distinct sets of adhesion molecules. J Immunol 2001; 166: 4650-7. DOI: https://doi.org/10.4049/jimmunol.166.7.4650
Arvikar SL, Fisher MC. Inflammatory bowel disease associated arthropathy. Curr Rev Musculoskelet Med 2011; 4: 123-31. DOI: https://doi.org/10.1007/s12178-011-9085-8
May E, Märker-Hermann E, Wittig BM, Zeitz M, Büschenfelde KMZ, Duchmann R. Identical T-cell expansions in the colon mucosa and the synovium of a patient with enterogenic spondyloarthropathy. Gastroenterology 2000; 119: 1745-55. DOI: https://doi.org/10.1053/gast.2000.20173
Maaser C, Sturm A, Vavricka SR, Kucharzik T, Fiorino G, Annese V, et al. ECCO-ESGAR guideline for diagnostic assessment in IBD part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 2019; 13: 144-64. DOI: https://doi.org/10.1093/ecco-jcc/jjy113
Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: Definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis 2017; 11: 649–70. DOI: https://doi.org/10.1093/ecco-jcc/jjx008
Schoepfer AM, Dehlavi MA, Fournier N, Safroneeva E, Straumann A, Pittet V, et al. Diagnostic delay in crohn’s disease is associated with a complicated disease course and increased operation rate. Am J Gastroenterol 2013; 108: 1744-53. DOI: https://doi.org/10.1038/ajg.2013.248
Danese S, Fiorino G, Mary JY, Lakatos PL, D’Haens G, Moja L, et al. Development of red flags index for early referral of adults with symptoms and signs suggestive of Crohn’s disease: an IOIBD initiative. J Crohns Colitis 2015; 9: 601-6. DOI: https://doi.org/10.1093/ecco-jcc/jjv067
Nahon S, Lahmek P, Lesgourgues B, Poupardin C, Chaussade S, Peyrin-Biroulet L, et al. Diagnostic delay in a French cohort of Crohn’s disease patients. J Crohns Colitis 2014; 8: 964-9. DOI: https://doi.org/10.1016/j.crohns.2014.01.023
Sempere L, Bernabeu P, Cameo J, Gutiérrez A, García MG, García MF, et al. Gender biases and diagnostic delay in inflammatory bowel disease: multicenter observational study. Inflamm Bowel Dis 2023; 29: 1886-94. DOI: https://doi.org/10.1093/ibd/izad001
Fauny M, D’Amico F, Bonovas S, Netter P, Danese S, Loeuille D, et al. Faecal calprotectin for the diagnosis of bowel inflammation in patients with rheumatological diseases: a systematic review. J Crohns Colitis 2020; 14: 688-93. DOI: https://doi.org/10.1093/ecco-jcc/jjz205
Ananthakrishnan AN, Adler J, Chachu KA, Nguyen NH, Siddique SM, Weiss JM, et al. AGA Clinical practice guideline on the role of biomarkers for the management of crohn’s disease. Gastroenterology 2023; 165: 1367-99. DOI: https://doi.org/10.1053/j.gastro.2023.09.029
Feng HY, Chan CH, Chu YC, Qu XM, Wang YH, Wei JCC. Patients with ankylosing spondylitis have high risk of irritable bowel syndrome: a long-term nationwide population-based cohort study. Postgrad Med 2022; 134: 290-6. DOI: https://doi.org/10.1080/00325481.2022.2041338
Felice C, Leccese P, Scudeller L, Lubrano E, Cantini F, Castiglione F, et al. Red flags for appropriate referral to the gastroenterologist and the rheumatologist of patients with inflammatory bowel disease and spondyloarthritis. Clin Exp Immunol 2019; 196: 123-38. DOI: https://doi.org/10.1111/cei.13246
Fiorino G, Bonovas S, Gilardi D, Di Sabatino A, Allocca M, Furfaro F, et al. Validation of the red flags index for early diagnosis of crohn’s disease: a prospective observational IG-IBD study among general practitioners. J Crohns Colitis 2021; 14: 1777-9. DOI: https://doi.org/10.1093/ecco-jcc/jjaa111
Scott FI, Ehrlich O, Wood D, Viator C, Rains C, DiMartino L, et al. Creation of an inflammatory bowel disease referral pathway for identifying patients who would benefit from inflammatory bowel disease specialist consultation. Inflamm Bowel Dis 2023; 29: 1177-90. DOI: https://doi.org/10.1093/ibd/izac216
Rudwaleit M, Van Der Heijde D, Landewé R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70: 25-31. DOI: https://doi.org/10.1136/ard.2010.133645
Salvarani C, Fries W. Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease. World J Gastroenterol 2009; 15: 2449-55. DOI: https://doi.org/10.3748/wjg.15.2449
Sieper J, Van Der Heijde D, Landewé R, Brandt J, Burgos-Vagas R, Collantes-Estevez E, et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis 2009; 68: 784-8. DOI: https://doi.org/10.1136/ard.2008.101501
Zhao SS, Pittam B, Harrison NL, Ahmed AE, Goodson NJ, Hughes DM. Diagnostic delay in axial spondyloarthritis: A SYSTEMATIC REVIEW AND META-ANALYSIS. Rheumatology 2021; 60: 1620-8. DOI: https://doi.org/10.1093/rheumatology/keaa807
Di Carlo M, Luchetti MM, Benfaremo D, Di Donato E, Mosca P, Maltoni S, et al. The DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire: development and preliminary testing of a new tool to screen patients with inflammatory bowel disease for the presence of spondyloarthritis. Clin Rheumatol 2018; 37: 1037-44. DOI: https://doi.org/10.1007/s10067-017-3937-6
Benfaremo D, Luchetti MM, Di Carlo M, Salaffi F, Gabrielli A, Benedetti A, et al. Multicenter validation of the DETAIL questionnaire for the screening of spondyloarthritis in patients with inflammatory bowel diseases. J Rheumatol 2021; 48: 179-87. DOI: https://doi.org/10.3899/jrheum.200364
Variola A, Zanolin ME, Cipriano G, Macchioni P, Martinis F, Pasetti A, et al. The IBIS-Q [IBd Identification of Spondyloarthritis Questionnaire]: a novel tool to detect both axial and peripheral arthritis in inflammatory bowel disease patients. J Crohns Colitis 2020; 14: 1680-6. DOI: https://doi.org/10.1093/ecco-jcc/jjaa096
Jovaní V, Blasco-Blasco M, Ruiz-Cantero MT, Pascual E. Understanding how the diagnostic delay of spondyloarthritis differs between women and men: a systematic review and metaanalysis. J Rheumatol 2017; 44: 174-83. DOI: https://doi.org/10.3899/jrheum.160825
Garrido-Cumbrera M, Navarro-Compán V, Bundy C, Mahapatra R, Makri S, Correa-Fernández J, et al. Identifying parameters associated with delayed diagnosis in axial spondyloarthritis: data from the European map of axial spondyloarthritis. Rheumatology 2022; 61: 705-12. DOI: https://doi.org/10.1093/rheumatology/keab369
Garrido-Cumbrera M, Poddubnyy D, Gossec L, Mahapatra R, Bundy C, Makri S, et al. Gender differences in patient journey to diagnosis and disease outcomes: results from the European Map of Axial Spondyloarthritis (EMAS). Clin Rheumatol 2021; 40: 2753-61. DOI: https://doi.org/10.1007/s10067-020-05558-7
Redeker I, Callhoff J, Hoffmann F, Haibel H, Sieper J, Zink A, et al. Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Rheumatology 2019; 58: 1634-8. DOI: https://doi.org/10.1093/rheumatology/kez090
Lee SC, Yang CH, Tsai YC, Yu KH. The effect of uveitis and undiagnosed spondyloarthritis: a systematic review and meta-analysis. Sci Rep 2023; 13: 14779. DOI: https://doi.org/10.1038/s41598-023-41971-z
Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE. Gender differences in axial spondyloarthritis: women are not so lucky. Curr Rheumatol Rep 2018; 20: 35. DOI: https://doi.org/10.1007/s11926-018-0744-2
Reveille JD. Biomarkers in axial spondyloarthritis and low back pain: a comprehensive review. Clin Rheumatol 2022; 41: 617-34. DOI: https://doi.org/10.1007/s10067-021-05968-1
Sanz Sanz J, Juanola Roura X, Seoane-Mato D, Montoro M, Gomollón F. Screening of inflammatory bowel disease and spondyloarthritis for referring patients between rheumatology and gastroenterology. Reumatol Clin (Engl Ed) 2018; 14: 68-74. DOI: https://doi.org/10.1016/j.reumae.2017.07.001
Conigliaro P, Chimenti MS, Ascolani M, Triggianese P, Novelli L, Onali S, et al. Impact of a multidisciplinary approach in enteropathic spondyloarthritis patients. Autoimmun Rev 2016; 15: 184-90. DOI: https://doi.org/10.1016/j.autrev.2015.11.002
Kumthekar A, Bittar M, Dubreuil M. Educational needs and challenges in axial spondyloarthritis. Curr Opin Rheumatol 2021; 33: 313-8. DOI: https://doi.org/10.1097/BOR.0000000000000806
Mathieson HR, Merashli M, Gaffney K, Marzo-Ortega H. Poor awareness of inflammatory back pain and axial spondyloarthritis among secondary care specialists. Clin Rheumatol 2016; 35: 2627-8. DOI: https://doi.org/10.1007/s10067-016-3305-y
Ossum AM, Palm Ø, Cvancarova M, Bernklev T, Jahnsen J, Moum B, et al. The impact of spondyloarthritis and joint symptoms on health-related quality of life and fatigue in IBD patients. Results from a population-based inception cohort (20-year follow-up in the Ibsen Study). Inflamm Bowel Dis 2020; 26: 114-24. DOI: https://doi.org/10.1093/ibd/izz105
Inman RD, Garrido-Cumbrera M, Chan J, Cohen M, de Brum-Fernandes AJ, Gerhart W, et al. Work-related issues and physical and psychological burden in canadian patients with axial spondyloarthritis: results from the international map of axial spondyloarthritis. J Rheumatol 2023; 50: 625-33. DOI: https://doi.org/10.3899/jrheum.220596
Rizzello F, Olivieri I, Armuzzi A, Ayala F, Bettoli V, Bianchi L, et al. Multidisciplinary management of spondyloarthritis-related immune-mediated inflammatory disease. Adv Ther 2018; 35: 545-62. DOI: https://doi.org/10.1007/s12325-018-0672-6
Dos Reis Annunciato D, Oliveira TL, Magalhães VO, de Medeiros Pinheiro M. Extra-musculoskeletal manifestations driving the therapeutic decision-making in patients with spondyloarthritis: a 12-month follow-up prospective cohort study. Adv Rheumatol 2023; 63: 44. DOI: https://doi.org/10.1186/s42358-023-00324-0
Cozzi G, Scagnellato L, Lorenzin M, Savarino E, Zingone F, Ometto F, et al. Spondyloarthritis with inflammatory bowel disease: the latest on biologic and targeted therapies. Nat Rev Rheumatol 2023; 19: 503-18. DOI: https://doi.org/10.1038/s41584-023-00984-8
Lorenzetti R, Scolieri P, Guarini A, de Marinis F, Zullo A, Hassan C, et al. Integrated gastroenterology and rheumatology ambulatory: an innovative approach for enteropathic spondyloarthritis early diagnosis. Ann Ist Super Sanita 2019; 55: 246-8.
Torres J, Chaparro M, Julsgaard M, Katsanos K, Zelinkova Z, Agrawal M, et al. European crohn’s and colitis guidelines on sexuality, fertility, pregnancy, and lactation. J Crohns Colitis 2023; 17: 1-27. DOI: https://doi.org/10.1093/ecco-jcc/jjac115

How to Cite

Caranfil, C., Lorenzon, G., Barberio, B., Ramonda, R., Savarino, E., & Zingone, F. (2024). Inflammatory bowel diseases and spondyloarthritis: a focus on female patients. Reumatismo, 76(3). https://doi.org/10.4081/reumatismo.2024.1770
Copyright (c) 2024 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.