Infliximab in spondyloarthropathy associated with Crohn's disease: an open study on the efficacy of inducing and maintaining remission of musculoskeletal and gut manifestations

Objective: To evaluate the efficacy and tolerability of anti-tumour necrosis factor a (TNFa) monoclonalantibody (infliximab) in the treatment of spondyloarthropathy (SpA) associated with active and inactiveCrohn’s disease (CD).Methods: Twenty four patients with SpA associated with active or inactive CD (16 active, 8 quiescent) weretreated with anti-TNFa monoclonal antibody (infliximab) with repeated infusions for a period of12–18 months. The treatment aimed at ameliorating the general musculoskeletal and spinal pain,controlling peripheral arthritis and enthesitis, decreasing the BASDAI score, modifying acute phasereactants, and reducing CD activity.Results: Infliximab improved both gastrointestinal (p,0.01) and overall articular symptoms (BASDAI,p,0.01; general musculoskeletal and spinal pain, p,0.01; peripheral arthritis, p,0.01) in patients withactive CD. Additionally, infliximab effectively controlled not only axial involvement and peripheral arthritisbut also enthesitis (p,0.01) and prevented inflammatory bowel disease reactivation in patients withinactive CD and low inflammatory markers. Amelioration of gut and musculoskeletal involvement persistedfor up to 12 months.Conclusion: Infliximab may act on the inflammation of entheses and of periarticular structures, whichusually does not cause a change in the haematological markers that are the main indicators of pain andjoint ankylosis in SpA. Infliximab induces and maintains remission of CD while at the same time treatingactive and severe SpA, suggesting that it should be the preferred drug for the treatment of active andsevere SpA associated with active or quiescent CD.