Inflammatory Bowel Disease-related Spondyloarthritis: The Last Unexplored Territory of Rheumatology.

The Spondyloarthritides (SpA) are a group of chronic inflammatory d iseases a ffecting th e spine, peripheral joints and entheses, as well as extra-skeletal structures, including the gastrointestinal tract. On the other hand, inflammatory b owel d isease (IBD), e ither Crohn's d isease o r ulcerative colitis, often affects extra-intestinal sites, including the axial and/or peripheral skeleton. IBD-related arthritis is the type of SpA that occurs in patients affected by IBD, with an incidence up to 50% during the IBD course. Although both manifestations are apparently the result of a common pathogenetic process, physicians often fail to recognize the disease in its entirety: thus, IBD-SpA is managed as two separate diseases, a musculoskeletal and a gastrointestinal one, with a profound impact on patient quality of life. Moreover, the specialty of the treating physician determines the clinical and laboratory tools for disease assessment, which, in turn, guide treatment decisions that may overlook either affected system or even act in the opposite direction. Raising awareness of the intestinal and musculoskeletal manifestations among rheumatologists and gastroenterologists will lead to earlier diagnosis and a multidisciplinary approach, particularly regarding pharmacologic treatments. Given the lack of trial evidence on immunomodulatory drugs in IBD-SpA it is imperative for researchers in both medical disciplines to join efforts, in order to determine referral strategies, appropriate composite measures for disease assessment, treatment algorithms and therapeutic targets.

Multiple sclerosis in a patient with cryopyrin-associated autoinflammatory syndrome: Evidence that autoinflammation is the common link.

The co-existence of an autoinflammatory syndrome with a demyelinating disorder is a very rare occurrence raising the question whether there is a pathophysiological connection between them. We describe the case of a man with symptoms of cryopyrin-associated periodic syndrome (CAPS) since infancy who later developed multiple sclerosis (MS). As CAPS was genetically confirmed, the inhibition of interleukin-1 (IL-1) with anakinra led to a swift resolution of the CAPS symptoms and also, in combination with teriflunomide, to a clinical and imaging improvement of MS. In vitro studies showed that, upon a CAPS flare, the patient's peripheral neutrophils released neutrophil extracellular traps (NETs) decorated with IL-1ß, while NET release was markedly decreased following anakinra-induced remission of CAPS. Taking into account the growing evidence on the involvement of IL-1ß in experimental models of MS, this rare patient case suggests that the role of neutrophils/NETs and IL-1ß in MS should be further studied.