rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2015-190-199rsp-2075Research ArticleОБЗОРREVIEWПОРАЖЕНИЕ КИШЕЧНИКА У БОЛЬНЫХ СПОНДИЛОАРТРИТАМИBOWEL INVOLVEMENT IN PATIENTS WITH SPONDYLOARTHRITISКаратеевА. Е.KarateevA. E.

Контакты: Андрей Евгеньевич Каратеев; aekarateev@rambler.ru

Contact: Andrei Karateev; aekarateev@rambler.ru

aekarateev@rambler.ruГалушкоЕ. А.GalushkoE. A.aekarateev@rambler.ruНаучноисследовательский институт ревматологии им В.А. Насоновой, МоскваРоссия201529042015532190199Copyright © Каратеев А.Е., Галушко Е.А., 20152015Каратеев А.Е., Галушко Е.А.Karateev A.E., Galushko E.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2075

Патогенетическая и клиническая ассоциация между спондилоартритами (СпА) и воспалительными заболеваниями  кишечника (ВЗК) хорошо известна. Язвенный  колит и болезнь Крона значительно чаще встречаются у больных СпА, чем в популяции. В свою очередь, поражение  позвоночника и периферических суставов является  типичным системным  проявлением ВЗК. Но при этом не менее половины  больных СпА имеют эндоскопические и гистологические признаки хронического  воспаления слизистой оболочки тонкой и толстой кишки, которые не сопровождаются отчетливо выраженными клиническими проявлениями и не могут рассматриваться в рамках конкретной нозологической формы. Значение этой патологии  до настоящего  времени неясно.  Следует ли рассматривать бессимптомное кишечное  воспаление  как предвестник развития «настоящих» ВЗК, какие методы следует использовать  для диагностики поражения кишечника и как наличие этой патологии  влияет на выбор рациональной фармакотерапии СпА? В настоящем обзоре представлен анализ основных  данных литературы,  касающихся этой проблемы.

The pathogenetic  and clinical association between spondyloarthritis  (SpA) and inflammatory bowel diseases (IBD) is well known. Ulcerative colitis and Crohn's disease are more common  in patients with SpA than in general population. In turn, the involvement of the spine and peripheral joints is a typical systemic manifestation  of IBD. But at the same time at least half of patients with SpA have endoscopic and histological signs of chronic inflammation of the small and large intestine mucosa, which are unaccompanied by characteristic  clinical manifestations and cannot considered within a specific nosological entity. The importance  of this pathology has been unknown until the present time. Should asymptomatic  bowel inflammation be considered as a precursor of true IBD, which methods should be used to diagnose bowel involvement and how the presence of this pathology affects the choice of rational pharmacotherapy for SpA? This review analyzes the basic literature data concerning this problem.

: спондилоартритвоспалительные заболевания кишечникатонкая кишкатолстая кишкахроническое воспалениефиброколоноскопиявидеокапсульная эндоскопиякальпротектинфармакотерапиянестероидные противовоспалительные препаратыspondyloarthritisinflammatory bowel diseasessmall intestinelarge intestinechronic inflammationfibrocolonoscopyvideo capsule endoscopycalprotectinpharmacotherapynonsteroidal anti-inflammatory drugsbiological agentsReferencesНасонова ВА, Бунчук НВ, редакторы. Ревматические болезни. Москва: Медицина; 1997. 509 с. [Nasonova VA, Bunchuk NV, editors. Revmaticheskie bolezni [Rheumatic diseases]. Moscow: Medizina; 1997. 509 p.].Насонова ВА, Бунчук НВ, редакторы. Ревматические болезни. Москва: Медицина; 1997. 509 с. [Nasonova VA, Bunchuk NV, editors. Revmaticheskie bolezni [Rheumatic diseases]. Moscow: Medizina; 1997. 509 p.].Peluso R, DiMinno M, Iervolino S, et al. Enteropathic spondyloarthritis: from diagnosis to treatment. Clin Dev Immunol. 2013;2013:631408. doi: 10.1155/2013/631408Peluso R, DiMinno M, Iervolino S, et al. Enteropathic spondyloarthritis: from diagnosis to treatment. Clin Dev Immunol. 2013;2013:631408. doi: 10.1155/2013/631408Van Praet L, Jacques P, van den Bosch F, Elewaut D. The transition of acute to chronic bowel inflammation in spondyloarthritis. Nat Rev Rheumatol. 2012 Apr 17;8(5):288–95. doi: 10.1038/nrrheum.2012.42Van Praet L, Jacques P, van den Bosch F, Elewaut D. The transition of acute to chronic bowel inflammation in spondyloarthritis. Nat Rev Rheumatol. 2012 Apr 17;8(5):288–95. doi: 10.1038/nrrheum.2012.42Orlando A, Renna S, Perricone G, Cottone M. Gastrointestinal lesions associated with spondyloarthropathies. World J Gastroenterol. 2009 May 28;15(20):2443–8. doi: 10.3748/wjg.15.2443Orlando A, Renna S, Perricone G, Cottone M. Gastrointestinal lesions associated with spondyloarthropathies. World J Gastroenterol. 2009 May 28;15(20):2443–8. doi: 10.3748/wjg.15.2443Smith R. The surgical relief of intestinal foci of infection in cases of arthritis deformans. Ann Surg. 1922;76(4):513–8. doi: 10.1097/00000658-192210000-00016Smith R. The surgical relief of intestinal foci of infection in cases of arthritis deformans. Ann Surg. 1922;76(4):513–8. doi: 10.1097/00000658-192210000-00016Tiwana H, Natt RS, Benitez-Brito R, et al. Correlation between the immune responses to collagens type I, III, IV and V and Klebsiella pneumoniae in patients with Crohn's disease and ankylosing spondylitis. Rheumatology (Oxford). 2001;40(1):15–23. doi: 10.1093/rheumatology/40.1.15Tiwana H, Natt RS, Benitez-Brito R, et al. Correlation between the immune responses to collagens type I, III, IV and V and Klebsiella pneumoniae in patients with Crohn's disease and ankylosing spondylitis. Rheumatology (Oxford). 2001;40(1):15–23. doi: 10.1093/rheumatology/40.1.15Costello ME, Elewaut D, Kenna TJ, Brown MA. Microbes, the gut and ankylosing spondylitis. Arthritis Res Ther. 2013;15(3):214. doi: 10.1186/ar4228Costello ME, Elewaut D, Kenna TJ, Brown MA. Microbes, the gut and ankylosing spondylitis. Arthritis Res Ther. 2013;15(3):214. doi: 10.1186/ar4228Ciccia F, Alessandro R, Rizzo A, et al. Macrophage phenotype in the subclinical gut inflammation of patients with ankylosing spondylitis. Rheumatology (Oxford). 2014;53(1):104–13. doi: 10.1093/rheumatology/ket323. Epub 2013 Sep 29.Ciccia F, Alessandro R, Rizzo A, et al. Macrophage phenotype in the subclinical gut inflammation of patients with ankylosing spondylitis. Rheumatology (Oxford). 2014;53(1):104–13. doi: 10.1093/rheumatology/ket323. Epub 2013 Sep 29.Ciccia F, Accardo-Palumbo A, Rizzo A, et al. Evidence that autophagy, but not the unfolded protein response, regulates the expression of IL-23 in the gut of patients with ankylosing spondylitis and subclinical gut inflammation. Ann Rheum Dis. 2014;73(8):1566–74. doi: 10.1136/annrheumdis-2012-202925. Epub 2013 Jun 5.Ciccia F, Accardo-Palumbo A, Rizzo A, et al. Evidence that autophagy, but not the unfolded protein response, regulates the expression of IL-23 in the gut of patients with ankylosing spondylitis and subclinical gut inflammation. Ann Rheum Dis. 2014;73(8):1566–74. doi: 10.1136/annrheumdis-2012-202925. Epub 2013 Jun 5.Martinez-Gonzalez O, Cantero-Hinojosa J, Paule-Sastre P, et al. Intestinal permeability in patients with ankylosing spondylitis and their healthy relatives. Br J Rheumatol. 1994;33(7):644–7. doi: 10.1093/rheumatology/33.7.644Martinez-Gonzalez O, Cantero-Hinojosa J, Paule-Sastre P, et al. Intestinal permeability in patients with ankylosing spondylitis and their healthy relatives. Br J Rheumatol. 1994;33(7):644–7. doi: 10.1093/rheumatology/33.7.644Агабабова ЭР, Бунчук НВ, Кузин АВ, Румянцев ВА. Серонегативный спондилоартрит при болезни Крона. Врач. 2002;(9):12–15 [Agababova ER, Bunchuk NV, Kuzin AV Rumyantsev VA Seronegative spondyloarthritis in Crohn's disease. Vrach. 2002;(9):12–5. (In Russ.)].Агабабова ЭР, Бунчук НВ, Кузин АВ, Румянцев ВА. Серонегативный спондилоартрит при болезни Крона. Врач. 2002;(9):12–15 [Agababova ER, Bunchuk NV, Kuzin AV Rumyantsev VA Seronegative spondyloarthritis in Crohn's disease. Vrach. 2002;(9):12–5. (In Russ.)].Вороненко ВА, Гуляев СВ. Хроническое воспалительное поражение кишечника и серонегативные спондилоартриты. Научно-практическая ревматология. 2005;(5):67–9. [Voronenko VA, Gulyaev SV Chronic inflammation of the intestines and seronegative spondylitis. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2005;(5):67–9. (In Russ.)]. doi: 10.14412/1995-4484-2005-47Вороненко ВА, Гуляев СВ. Хроническое воспалительное поражение кишечника и серонегативные спондилоартриты. Научно-практическая ревматология. 2005;(5):67–9. [Voronenko VA, Gulyaev SV Chronic inflammation of the intestines and seronegative spondylitis. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2005;(5):67–9. (In Russ.)]. doi: 10.14412/1995-4484-2005-47Court-Brown WM, Doll R. Leukaemia and aplastic anaemia in patients irradiated for ankylosing spondylitis. 1957. J Radiol Prot.2007;27(4B):B15–B154. doi: 10.1088/0952-4746/27/4B/001. Epub 2007 Nov 27.Court-Brown WM, Doll R. Leukaemia and aplastic anaemia in patients irradiated for ankylosing spondylitis. 1957. J Radiol Prot.2007;27(4B):B15–B154. doi: 10.1088/0952-4746/27/4B/001. Epub 2007 Nov 27.Jayson M, Salmon P, Harrison W. Inflammatory bowel disease in ankilosing spondylitis. Gut. 1970;11(6):506–11. doi: 10.1136/gut.11.6.506Jayson M, Salmon P, Harrison W. Inflammatory bowel disease in ankilosing spondylitis. Gut. 1970;11(6):506–11. doi: 10.1136/gut.11.6.506Leirisalo-Repo M, Turunen U, Stenman S, et al. High frequency of silent inflammatory bowel disease in spondylarthropathy. Arthritis Rheum. 1994;37(1):23–31. doi: 10.1002/art.1780370105Leirisalo-Repo M, Turunen U, Stenman S, et al. High frequency of silent inflammatory bowel disease in spondylarthropathy. Arthritis Rheum. 1994;37(1):23–31. doi: 10.1002/art.1780370105Lee YH, Ji JD, Kim JS, et al. Ileocolonoscopic and histologic studies of Korean patients with ankylosing spondylitis. Scand J Rheumatol. 1997;26(6):473–6. doi: 10.3109/03009749709065722Lee YH, Ji JD, Kim JS, et al. Ileocolonoscopic and histologic studies of Korean patients with ankylosing spondylitis. Scand J Rheumatol. 1997;26(6):473–6. doi: 10.3109/03009749709065722Porzio V, Biasi G, Corrado A, et al. Intestinal histological and ultrastructural inflammatory changes in spondyloarthropathy and rheumatoid arthritis. Scand J Rheumatol. 1997;26(2):92–8. doi: 10.3109/03009749709115825Porzio V, Biasi G, Corrado A, et al. Intestinal histological and ultrastructural inflammatory changes in spondyloarthropathy and rheumatoid arthritis. Scand J Rheumatol. 1997;26(2):92–8. doi: 10.3109/03009749709115825Scarpa R, Manguso F, D'Arienzo A, et al. Microscopic inflammatory changes in colon of patients with both active psoriasis and psoriatic arthritis without bowel symptoms. J Rheumatol. 2000;27(5):1241–6.Scarpa R, Manguso F, D'Arienzo A, et al. Microscopic inflammatory changes in colon of patients with both active psoriasis and psoriatic arthritis without bowel symptoms. J Rheumatol. 2000;27(5):1241–6.Mielants H, Veys EM, de Vos M, et al. The evolution of spondyloarthropathies in relation to gut histology. I. Clinical aspects. J Rheumatol. 1995;22(12):2266–72.Mielants H, Veys EM, de Vos M, et al. The evolution of spondyloarthropathies in relation to gut histology. I. Clinical aspects. J Rheumatol. 1995;22(12):2266–72.Mielants H, Veys EM, Cuvelier C, et al. The evolution of spondyloarthropathies in relation to gut histology. II. Histological aspects. J Rheumatol. 1995;22(12):2273–8.Mielants H, Veys EM, Cuvelier C, et al. The evolution of spondyloarthropathies in relation to gut histology. II. Histological aspects. J Rheumatol. 1995;22(12):2273–8.Mielants H, Veys EM, Cuvelier C, et al. The evolution of spondyloarthropathies in relation to gut histology. III. Relation between gut and joint. J Rheumatol. 1995; 22(12):2279–84.Mielants H, Veys EM, Cuvelier C, et al. The evolution of spondyloarthropathies in relation to gut histology. III. Relation between gut and joint. J Rheumatol. 1995; 22(12):2279–84.Van Praet L, van den Bosch FE, Jacques P, et al. Microscopic gut inflammation in axial spondyloarthritis: a multiparametric predictive model. Ann Rheum Dis. 2013;72(3):414–7. doi: 10.1136/annrheumdis-2012-202135. Epub 2012 Nov 8.Van Praet L, van den Bosch FE, Jacques P, et al. Microscopic gut inflammation in axial spondyloarthritis: a multiparametric predictive model. Ann Rheum Dis. 2013;72(3):414–7. doi: 10.1136/annrheumdis-2012-202135. Epub 2012 Nov 8.Lamarque D, Nhieu JT, Breban M, et al. Lymphocytic infiltration and expression of inducible nitric oxide synthase in human duodenal and colonic mucosa is a characteristic feature of ankylosing spondylitis. J Rheumatol. 2003;30(11):2428–36.Lamarque D, Nhieu JT, Breban M, et al. Lymphocytic infiltration and expression of inducible nitric oxide synthase in human duodenal and colonic mucosa is a characteristic feature of ankylosing spondylitis. J Rheumatol. 2003;30(11):2428–36.Kefalakes H, Stylianides TJ, Amanakis G, Kolios G. Exacerbation of inflammatory bowel diseases associated with the use of nonsteroidal anti-inflammatory drugs: myth or reality? Eur J Clin Pharmacol. 2009;65(10):963–70. doi: 10.1007/s00228-009-0719-3. Epub 2009 Aug 27.Kefalakes H, Stylianides TJ, Amanakis G, Kolios G. Exacerbation of inflammatory bowel diseases associated with the use of nonsteroidal anti-inflammatory drugs: myth or reality? Eur J Clin Pharmacol. 2009;65(10):963–70. doi: 10.1007/s00228-009-0719-3. Epub 2009 Aug 27.Takeuchi K, Smale S, Premchand P, et al. Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006;4(2):196–202. doi: 10.1016/S1542-3565(05)00980-8Takeuchi K, Smale S, Premchand P, et al. Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006;4(2):196–202. doi: 10.1016/S1542-3565(05)00980-8Felder JB, Korelitz BI, Rajapakse R, et al. Effects of nonsteroidal antiinflammatory drugs on inflammatory bowel disease: a casecontrol study. Am J Gastroenterol. 2000;95(8):1949–54. doi: 10.1111/j.1572-0241.2000.02262.xFelder JB, Korelitz BI, Rajapakse R, et al. Effects of nonsteroidal antiinflammatory drugs on inflammatory bowel disease: a casecontrol study. Am J Gastroenterol. 2000;95(8):1949–54. doi: 10.1111/j.1572-0241.2000.02262.xКаратеев АЕ, Бочкова АГ, Румянцева ОА и др. Применение капсульной эндоскопии для оценки влияния мелоксикама и диклофенака на слизистую оболочку тонкой кишки у больных с анкилозирующим спондилитом: первый опыт. Научно-практическая ревматология. 2011;(4):31–5.[Karateev AE, Bochkova AG, Rumyantsevа OA, et al. The use of capsule endoscopy to evaluate the effect of meloxicam and diclofenac on the mucosa of the small intestine in patients with ankylosing spondylitis: the first experience. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2011;(4):31–5. (In Russ.)]. doi: 10.14412/1995-4484-2011-4Каратеев АЕ, Бочкова АГ, Румянцева ОА и др. Применение капсульной эндоскопии для оценки влияния мелоксикама и диклофенака на слизистую оболочку тонкой кишки у больных с анкилозирующим спондилитом: первый опыт. Научно-практическая ревматология. 2011;(4):31–5.[Karateev AE, Bochkova AG, Rumyantsevа OA, et al. The use of capsule endoscopy to evaluate the effect of meloxicam and diclofenac on the mucosa of the small intestine in patients with ankylosing spondylitis: the first experience. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2011;(4):31–5. (In Russ.)]. doi: 10.14412/1995-4484-2011-4Davies N, Saleh J, Skjodt N. Detection and prevention of NSAID-induced enteropathy. J Pharm Pharm Sci. 2000;3(1):137–55.Davies N, Saleh J, Skjodt N. Detection and prevention of NSAID-induced enteropathy. J Pharm Pharm Sci. 2000;3(1):137–55.Syer S, Wallace JL. Environmental and NSAID-enteropathy: dysbiosis as a common factor. Curr Gastroenterol Rep. 2014;16(3):377. doi: 10.1007/s11894-014-0377-1Syer S, Wallace JL. Environmental and NSAID-enteropathy: dysbiosis as a common factor. Curr Gastroenterol Rep. 2014;16(3):377. doi: 10.1007/s11894-014-0377-1Allison M, Howatson A, Torrance C, et al. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drags. N Engl J Med. 1992;327(11):749–54. doi: 10.1056/NEJM199209103271101Allison M, Howatson A, Torrance C, et al. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drags. N Engl J Med. 1992;327(11):749–54. doi: 10.1056/NEJM199209103271101Sands G, Shell B, Zhang R. Adverse events in patients with blood loss: a pooled analysis of 51 clinical studies from the celecoxib clinical trial database. Open Rheumatol J. 2012;6:44–9. doi: 10.2174/1874312901206010044. Epub 2012 May 11.Sands G, Shell B, Zhang R. Adverse events in patients with blood loss: a pooled analysis of 51 clinical studies from the celecoxib clinical trial database. Open Rheumatol J. 2012;6:44–9. doi: 10.2174/1874312901206010044. Epub 2012 May 11.Goldstein J, Eisen G, Lewis B, et al. Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin Gastroenterol Hepatol. 2005;3(2):133–41. doi: 10.1016/S1542-3565(04)00619-6Goldstein J, Eisen G, Lewis B, et al. Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin Gastroenterol Hepatol. 2005;3(2):133–41. doi: 10.1016/S1542-3565(04)00619-6Goldstein J, Eisen G, Lewis B, et al. Small bowel mucosal injury is reduced in healthy subjects treated with celecoxib compared with ibuprofen plus omeprazole, as assessed by video capsule endoscopy. Aliment Pharmacol Ther. 2007;25(10):1211–22. doi: 10.1111/j.1365-2036.2007.03312.xGoldstein J, Eisen G, Lewis B, et al. Small bowel mucosal injury is reduced in healthy subjects treated with celecoxib compared with ibuprofen plus omeprazole, as assessed by video capsule endoscopy. Aliment Pharmacol Ther. 2007;25(10):1211–22. doi: 10.1111/j.1365-2036.2007.03312.xHawkey CJ, Ell C, Simon B, et al. Less small-bowel injury with lumiracoxib compared with naproxen plus omeprazole. Clin Gastroenterol Hepatol. 2008;6(5):536–44. doi: 10.1016/j.cgh.2007.12.023. Epub 2008 Jan 31.Hawkey CJ, Ell C, Simon B, et al. Less small-bowel injury with lumiracoxib compared with naproxen plus omeprazole. Clin Gastroenterol Hepatol. 2008;6(5):536–44. doi: 10.1016/j.cgh.2007.12.023. Epub 2008 Jan 31.Tacheci I, Bradna P, Douda T, et al. NSAID-induced enteropathy in rheumatoid arthritis patients with chronic occult gastrointestinal bleeding: A prospective capsule endoscopy study. Gastroenterol Res Pract. 2013;2013:268382. doi: 10.1155/2013/268382. Epub 2013 Dec 7.Tacheci I, Bradna P, Douda T, et al. NSAID-induced enteropathy in rheumatoid arthritis patients with chronic occult gastrointestinal bleeding: A prospective capsule endoscopy study. Gastroenterol Res Pract. 2013;2013:268382. doi: 10.1155/2013/268382. Epub 2013 Dec 7.Niccoli L, Nannini C, Cassara E, et al. Frequency of anemia of inflammation in patients with ankylosing spondylitis requiring anti-TNFα drugs and therapy-induced changes. Int J Rheum Dis. 2012;15(1):56–61. doi: 10.1111/j.1756-185X.2011.01662.x. Epub 2011 Sep 14.Niccoli L, Nannini C, Cassara E, et al. Frequency of anemia of inflammation in patients with ankylosing spondylitis requiring anti-TNFα drugs and therapy-induced changes. Int J Rheum Dis. 2012;15(1):56–61. doi: 10.1111/j.1756-185X.2011.01662.x. Epub 2011 Sep 14.Braun J, van der Heijde D, Doyle MK, et al. Improvement in hemoglobin levels in patients with ankylosing spondylitis treated with infliximab. Arthritis Rheum. 2009;61(8):1032–6. doi: 10.1002/art.24865.Braun J, van der Heijde D, Doyle MK, et al. Improvement in hemoglobin levels in patients with ankylosing spondylitis treated with infliximab. Arthritis Rheum. 2009;61(8):1032–6. doi: 10.1002/art.24865.Vucelic B. Inflammatory bowel diseases: controversies in the use of diagnostic procedures. Dig Dis. 2009;27(3):269–77. doi: 10.1159/000228560. Epub 2009 Sep 24.Vucelic B. Inflammatory bowel diseases: controversies in the use of diagnostic procedures. Dig Dis. 2009;27(3):269–77. doi: 10.1159/000228560. Epub 2009 Sep 24.Argü elles-Arias F, Rodriguez-Oballe J, Duarte-Chang C, et al. Capsule endoscopy in the small bowel crohn's disease. Gastroenterol Res Pract. 2014;2014:529136. doi: 10.1155/2014/529136. Epub 2014 Mar 11.Argü elles-Arias F, Rodriguez-Oballe J, Duarte-Chang C, et al. Capsule endoscopy in the small bowel crohn's disease. Gastroenterol Res Pract. 2014;2014:529136. doi: 10.1155/2014/529136. Epub 2014 Mar 11.Leighton JA, Legnani P, Seidman EG. Role of capsule endoscopy in inflammatory bowel disease: where we are and where we are going. Inflamm Bowel Dis. 2007;13(3):331–7. doi: 10.1002/ibd.20058Leighton JA, Legnani P, Seidman EG. Role of capsule endoscopy in inflammatory bowel disease: where we are and where we are going. Inflamm Bowel Dis. 2007;13(3):331–7. doi: 10.1002/ibd.20058Dionisio P, Gurudu S, Leighton J, et al. Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small-bowel Crohn's disease: a meta-analysis. Am J Gastroenterol. 2010;105(6):1240–8. doi: 10.1038/ajg.2009.713. Epub 2009 Dec 22.Dionisio P, Gurudu S, Leighton J, et al. Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small-bowel Crohn's disease: a meta-analysis. Am J Gastroenterol. 2010;105(6):1240–8. doi: 10.1038/ajg.2009.713. Epub 2009 Dec 22.Li F, Gurudu S, de Petris G, et al. Retention of the capsule endoscope: a single-center experience of 1000 capsule endoscopy procedures. Gastrointest Endosc. 2008;68(1):174–80. doi: 10.1016/j.gie.2008.02.037. Epub 2008 Jun 2.Li F, Gurudu S, de Petris G, et al. Retention of the capsule endoscope: a single-center experience of 1000 capsule endoscopy procedures. Gastrointest Endosc. 2008;68(1):174–80. doi: 10.1016/j.gie.2008.02.037. Epub 2008 Jun 2.Abraham BP, Kane S. Fecal markers: calprotectin and lactoferrin. Gastroenterol Clin North Am. 2012;41(2):483–95. doi: 10.1016/j.gtc.2012.01.007. Epub 2012 Feb 16.Abraham BP, Kane S. Fecal markers: calprotectin and lactoferrin. Gastroenterol Clin North Am. 2012;41(2):483–95. doi: 10.1016/j.gtc.2012.01.007. Epub 2012 Feb 16.Langhorst J, Elsenbruch S, Koelzer J, et al. Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol. 2008;103(1):162–9. doi: 10.1111/j.1572-0241.2007.01556.x. Epub 2007 Oct 4.Langhorst J, Elsenbruch S, Koelzer J, et al. Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol. 2008;103(1):162–9. doi: 10.1111/j.1572-0241.2007.01556.x. Epub 2007 Oct 4.Montalto M, Gallo A, Santoro L, et al. Role of fecal calprotectin in gastrointestinal disorders. Eur RevMed Pharm Sci. 2013;17:1569–82.Montalto M, Gallo A, Santoro L, et al. Role of fecal calprotectin in gastrointestinal disorders. Eur RevMed Pharm Sci. 2013;17:1569–82.Klingberg E, Carlsten H, Hilme E, et al. Calprotectin in ankylosing spondylitis-frequently elevated in feces, but normal in serum. Scand J Gastroenterol. 2012;47(4):435–44. doi:Klingberg E, Carlsten H, Hilme E, et al. Calprotectin in ankylosing spondylitis-frequently elevated in feces, but normal in serum. Scand J Gastroenterol. 2012;47(4):435–44. doi:3109/00365521.2011.648953. Epub 2012 Jan 10.47. Sandborn W, Stenson W, Brynskov J, et al. Safety of celecoxib in patients with ulcerative colitis in remission: a randomized, placebo-controlled, pilot study. Clin Gastroenterol Hepatol. 2006;4(2):203–11. doi: 10.1016/j.cgh.2005.12.0023109/00365521.2011.648953. Epub 2012 Jan 10.47. Sandborn W, Stenson W, Brynskov J, et al. Safety of celecoxib in patients with ulcerative colitis in remission: a randomized, placebo-controlled, pilot study. Clin Gastroenterol Hepatol. 2006;4(2):203–11. doi: 10.1016/j.cgh.2005.12.002El Miedany Y, Youssef S, Ahmed I, El Gaafary M. The gastrointestinal safety and effect on disease activity of etoricoxib, a selective cox-2 inhibitor in inflammatory bowel diseases. Am J Gastroenterol. 2006;101(2):311–7. doi: 10.1111/j.1572-0241.2006.00384.xEl Miedany Y, Youssef S, Ahmed I, El Gaafary M. The gastrointestinal safety and effect on disease activity of etoricoxib, a selective cox-2 inhibitor in inflammatory bowel diseases. Am J Gastroenterol. 2006;101(2):311–7. doi: 10.1111/j.1572-0241.2006.00384.xБелоусова ЕА. Европейский консенсус по лечению болезни Крона. Фарматека. 2008;156(2):52–7. [Belousova EA. European consensus for the treatment of Crohn's disease. Farmateka. 2008;156 (2):52–7. (In Russ.)].Белоусова ЕА. Европейский консенсус по лечению болезни Крона. Фарматека. 2008;156(2):52–7. [Belousova EA. European consensus for the treatment of Crohn's disease. Farmateka. 2008;156 (2):52–7. (In Russ.)].Белоусова ЕА. Рекомендации по диагностике и лечению болезни Крона. Фарматека. 2009;187(13):38–44. [Belousova EA. Recommendations for the diagnosis and treatment of Crohn's disease. Farmateka. 2009;187(13):38–44. (In Russ.)].Белоусова ЕА. Рекомендации по диагностике и лечению болезни Крона. Фарматека. 2009;187(13):38–44. [Belousova EA. Recommendations for the diagnosis and treatment of Crohn's disease. Farmateka. 2009;187(13):38–44. (In Russ.)].Ford AC, Bernstein CN, Khan KJ, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(4):590–9. doi: 10.1038/ajg.2011.70. Epub 2011 Mar 15.Ford AC, Bernstein CN, Khan KJ, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(4):590–9. doi: 10.1038/ajg.2011.70. Epub 2011 Mar 15.Насонов ЕЛ, редактор. Ревматология. Клинические рекомендации. Москва: ГЭОТАР-Медиа; 2010. 752 с. [Nasonov EL, editor. Revmatologiya. Klinicheskie rekomendatsii [Rheumatology. Clinical guidelines]. Moscow: GEOTAR Media; 2010. 752 p.].Насонов ЕЛ, редактор. Ревматология. Клинические рекомендации. Москва: ГЭОТАР-Медиа; 2010. 752 с. [Nasonov EL, editor. Revmatologiya. Klinicheskie rekomendatsii [Rheumatology. Clinical guidelines]. Moscow: GEOTAR Media; 2010. 752 p.].Fendler C, Baraliakos X, Braun J. Glucocorticoid treatment in spondyloarthritis. Clin Exp Rheumatol. 2011;29(5 Suppl 68):S139–42. Epub 2011 Oct 22.Fendler C, Baraliakos X, Braun J. Glucocorticoid treatment in spondyloarthritis. Clin Exp Rheumatol. 2011;29(5 Suppl 68):S139–42. Epub 2011 Oct 22.Chen J, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004800.Chen J, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004800.Lim WC, Hanauer S. Aminosalicylates for induction of remission or response in Crohn's disease. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD008870. doi: 10.1002/14651858.CD008870Lim WC, Hanauer S. Aminosalicylates for induction of remission or response in Crohn's disease. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD008870. doi: 10.1002/14651858.CD008870Ford AC, Kane SV, Khan KJ, et al. Efficacy of 5-aminosalicylates in Crohn's disease: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(4):617–29. doi: 10.1038/ajg.2011.71. Epub 2011 Mar 15.Ford AC, Kane SV, Khan KJ, et al. Efficacy of 5-aminosalicylates in Crohn's disease: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(4):617–29. doi: 10.1038/ajg.2011.71. Epub 2011 Mar 15.Van Denderen JC, van der Horst-Bruinsma I, Bezemer PD, Dijkmans BA. Efficacy and safety of mesalazine (Salofalk) in an open study of 20 patients with ankylosing spondylitis. J Rheumatol. 2003;30(7):1558–60.Van Denderen JC, van der Horst-Bruinsma I, Bezemer PD, Dijkmans BA. Efficacy and safety of mesalazine (Salofalk) in an open study of 20 patients with ankylosing spondylitis. J Rheumatol. 2003;30(7):1558–60.Chande N, Tsoulis DJ, MacDonald JK. Azathioprine or 6-mer-captopurine for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD000545. doi: 10.1002/14651858.CD000545.pub4Chande N, Tsoulis DJ, MacDonald JK. Azathioprine or 6-mer-captopurine for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD000545. doi: 10.1002/14651858.CD000545.pub4Le Quintrec JL, Menkes CJ, Amor B. Severe psoriatic rheumatism: treatment with azathioprine: report of 11 cases. Rev Rheum Mal Osteoartic. 1990;57(11):815–9.Le Quintrec JL, Menkes CJ, Amor B. Severe psoriatic rheumatism: treatment with azathioprine: report of 11 cases. Rev Rheum Mal Osteoartic. 1990;57(11):815–9.Durez P, Horsmans Y. Dramatic response after an intravenous loading dose of azathioprine in one case of severe and refractory ankylosing spondylitis. Rheumatology (Oxford). 2000;39(2):182–4. doi: 10.1093/rheumatology/39.2.182Durez P, Horsmans Y. Dramatic response after an intravenous loading dose of azathioprine in one case of severe and refractory ankylosing spondylitis. Rheumatology (Oxford). 2000;39(2):182–4. doi: 10.1093/rheumatology/39.2.182McDonald JW, Tsoulis DJ, Macdonald JK, Feagan BG. Methotrexate for induction of remission in refractory Crohn's disease. Cochrane Database Syst Rev. 2012 Dec 12;(12):CD003459. doi: 10.1002/14651858.CD003459.pub3McDonald JW, Tsoulis DJ, Macdonald JK, Feagan BG. Methotrexate for induction of remission in refractory Crohn's disease. Cochrane Database Syst Rev. 2012 Dec 12;(12):CD003459. doi: 10.1002/14651858.CD003459.pub3Chen J, Veras MM, Liu C, Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD004524. DOI: 10.1002/14651858.CD004524.pub4Chen J, Veras MM, Liu C, Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD004524. DOI: 10.1002/14651858.CD004524.pub4Ash Z, Gaujoux-Viala C, Gossec L, et al. A systematic literature review of drug therapies for the treatment of psoriatic arthritis: current evidence and meta-analysis informing the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis. 2012;71(3):319–26. doi: 10.1136/ard.2011.150995. Epub 2011 Jul 28.Ash Z, Gaujoux-Viala C, Gossec L, et al. A systematic literature review of drug therapies for the treatment of psoriatic arthritis: current evidence and meta-analysis informing the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis. 2012;71(3):319–26. doi: 10.1136/ard.2011.150995. Epub 2011 Jul 28.Senabre-Gallego JM, Santos-RamТrez C, Santos-Soler G, et al. Long-term safety and efficacy of etanercept in the treatment of ankylosing spondylitis. Patient Prefer Adherence. 2013;7:961–72. doi: 10.2147/PPA.S33109Senabre-Gallego JM, Santos-RamТrez C, Santos-Soler G, et al. Long-term safety and efficacy of etanercept in the treatment of ankylosing spondylitis. Patient Prefer Adherence. 2013;7:961–72. doi: 10.2147/PPA.S33109Sandborn WJ, Hanauer SB, Katz S, et al. Etanercept for active Crohn's disease: a randomized, double-blind, placebo-controlled trial. Gastroenterology. 2001;121(5):1088–94. doi: 10.1053/gast.2001.28674Sandborn WJ, Hanauer SB, Katz S, et al. Etanercept for active Crohn's disease: a randomized, double-blind, placebo-controlled trial. Gastroenterology. 2001;121(5):1088–94. doi: 10.1053/gast.2001.28674Behm BW, Bickston SJ. Tumor necrosis factor-alpha antibody for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD006893. doi: 10.1002/14651858.CD006893Behm BW, Bickston SJ. Tumor necrosis factor-alpha antibody for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD006893. doi: 10.1002/14651858.CD006893Van der Heijde D, Landewe R, Einstein S, et al. Radiographic progression of ankylosing spondylitis after up to two years of treatment with etanercept. Arthritis Rheum. 2008;58(5):1324–31. doi: 10.1002/art.23471Van der Heijde D, Landewe R, Einstein S, et al. Radiographic progression of ankylosing spondylitis after up to two years of treatment with etanercept. Arthritis Rheum. 2008;58(5):1324–31. doi: 10.1002/art.23471Van der Heijde D, Salonen D, Weissman B, et al. Assessment of radiographic progression in the spines of patients with ankylosing spondylitis treated with adalimumab for up to 2 years. Arthritis Res Ther. 2009;11(4):R127. doi: 10.1186/ar2794. Epub 2009 Aug 24.Van der Heijde D, Salonen D, Weissman B, et al. Assessment of radiographic progression in the spines of patients with ankylosing spondylitis treated with adalimumab for up to 2 years. Arthritis Res Ther. 2009;11(4):R127. doi: 10.1186/ar2794. Epub 2009 Aug 24.

The authors declare that there are no conflicts of interest present.