The treatment of the rheumatological manifestations of the inflammatory bowel diseases.

The strong link between the bowel and the osteo-articular system is suggested by many clinical and experimental observations. However, the therapeutic approach is still empirical. For symptomatic therapy it is better to favour the use of steroids and avoid non-steroidal anti-inflammatory drugs because they may induce intestinal ulcerations and can activate inflammatory bowel disease. Second line drugs (sulfasalazine, methotrexate, azathioprine, cyclosporine and leflunomide) should be used for selected indications. In some cases (severe spondylitis, severe and persistent enthesopathy) anti-TNF-alpha agents (infliximab) should be considered as first line therapy. In all cases it is mandatory to select the best therapeutic option for each individual patient, considering that the optimal treatment of bowel inflammation may induce "per se" a remission of the musculo-skeletal manifestations.