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Spine Feature

CT of Crohn’s Disease / Source: Wikimedia Commons and Samir

The Bacterial Link Between Crohn’s Disease and Arthritis

Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, March 6th, 2017

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A team of researchers from New York has filled in the blanks as to how Crohn’s disease and spondyloarthritis are related. The work, published February 8, 2017 in Science Translational Medicine, revealed a type of E. coli bacteria found in Crohn's patients that can trigger inflammation associated with spondyloarthritis.

According to the February 9, 2017 news release, “The researchers used fecal samples from patients with inflammatory bowel disease IBD to identify bacteria in the gut that were coated with antibodies called immunoglobulin-A (IgA) that fight infection. Using flow cytometry, in which fluorescent probes are used to detect IgA-coated bacterial species, the researchers discovered that IgA-coated E. coli were abundant in fecal samples from patients with both Crohn's disease and spondyloarthritis.”

“The investigators found that patients with Crohn's disease and spondyloarthritis had higher levels of Th17 cells, and that a protein called IL-23 triggers their activity. With the recent FDA approval of an anti-IL-23 medication for Crohn's disease called ustekinumab, the findings may help physicians select therapies that target symptoms of both the bowels and the joints in these patients.”

Randy Longman, M.D., Ph.D., a gastroenterologist at the Jill Roberts Center for Inflammatory Bowel Disease at Weill Cornell Medicine and NewYork-Presbyterian, led the translational study along with co-author Ellen Scherl, M.D., director of the Roberts Center at NewYork-Presbyterian and Weill Cornell Medicine and the Jill Roberts Professor of Medicine at Weill Cornell Medicine. They worked in collaboration with Hospital for Special Surgery rheumatologists and co-authors Drs. Lisa Mandl and Sergio Schwartzman.

Dr. Longman told OTW, “A critical clinical question for orthopedic surgeons is to differentiate inflammatory from non-inflammatory arthritis, since the treatment options—medicine vs. surgery—could be very different. While a diagnosis of rheumatoid arthritis, for example, will often trigger evaluation of inflammatory musculoskeletal pain, an existing diagnosis of inflammatory bowel disease (IBD) may not.”

“Our current data suggest that microbiome characteristics may identify Crohn’s patients with inflammatory arthritis. These findings highlight the need for careful evaluation of these symptoms in patients with IBD in order to identify the most appropriate therapeutic approach.”

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