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The transition of acute to chronic bowel inflammation in spondyloarthritis

Nature Reviews Rheumatology volume 8, pages 288–295 (2012)Cite this article

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Abstract

That gut and joint inflammation are linked in spondyloarthritis (SpA) has been recognized for almost three decades. Intriguingly, microscopic gut inflammation, which occurs frequently in patients with SpA, is an important risk factor for clinically overt Crohn's disease and ankylosing spondylitis. This Review describes current insights into the underlying mechanisms that lead to chronic gut inflammation in patients with SpA. We propose that the development of chronic bowel inflammation in these individuals occurs through a transition phase, in which inflammation evolves from an acute into a chronic state. Our transition model implies that different cell types are involved at different stages during disease progression, with stromal cells having an important role in chronicity. In addition, deficient regulatory feedback mechanisms or genetically determined alterations in antigen presentation, endoplasmic reticulum stress, autophagy or cytokine signaling might also favor a transition from self-limiting acute inflammation to chronic inflammation. We anticipate that this transition phase might be an important window for therapeutic intervention.

Key Points

  • Microscopic gut inflammation occurs in approximately two-thirds of patients with spondyloarthritis

  • Chronic inflammatory lesions are an important risk factor for the development of Crohn's disease and ankylosing spondylitis, therefore indicating a potential link between gut and joint inflammation

  • The transition of acute inflammatory lesions into chronic inflammatory lesions is influenced by deficient feedback of regulatory T cells

  • Mesenchymal cell types are important effector cells in the chronic phase of disease

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Figure 1: Transition of gut inflammation from acute to chronic in spondyloarthritis.
Figure 2: A unifying concept linking gut and joint inflammation in SpA: transition model.

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  1. Department of Rheumatology, Laboratory for Molecular Immunology and Inflammation, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium

    Liesbet Van Praet, Peggy Jacques, Filip Van den Bosch & Dirk Elewaut

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  1. Liesbet Van Praet
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  2. Peggy Jacques
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L. Van Praet and P. Jacques contributed equally to researching data for the article, discussing the content of the article and writing the article. F. Van den Bosch and D. Elewaut substantially contributed to discussions of the article content, wrote the article and reviewed and edited the manuscript before submission. D. Elewaut also researched some of the data for the article.

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Correspondence to Dirk Elewaut.

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Van Praet, L., Jacques, P., Van den Bosch, F. et al. The transition of acute to chronic bowel inflammation in spondyloarthritis. Nat Rev Rheumatol 8, 288–295 (2012). https://doi.org/10.1038/nrrheum.2012.42

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