Arthritis complicating inflammatory bowel disease – the future is now

Fundamental advances are occurring across immune-mediated inflammatory diseases (IMIDs). Recent therapeutic developments include strategies to prevent rheumatoid arthritis (RA) in high-risk individuals, using baseline cellular immunophenotypes to predict biologic response in psoriatic arthritis (PsA), and employing biologicals in a ‘top-down’ approach in Crohn’s disease (CD). However, meaningful progress has not occurred in the management of patients with spondyloarthropathy (SpA) complicating inflammatory bowel disease (IBD). Currently, the pathophysiology of IBD-related SpA is poorly understood, moreover, there remain no accepted or disease-specific screening tools, diagnostic criteria, or licenced treatment(s). Furthermore, current approaches to clinical care from rheumatologists and gastroenterologists largely involve the extrapolation of SpA and IBD clinical guidelines respectively, despite increasing recognition of IBDrelated SpA being its own entity, with a unique phenotype. There is an obvious contrast with the management of arthropathy complicating psoriasis, a disease area where defined diagnostic criteria and dedicated clinical trials allow clear management guidelines. We argue that the time has come for a parallel approach and dedicated focus of IBD-related SpA.