There is a general consensus that Crohn’s disease (CD) develops as the result of immune-mediated tissue damage triggered by infections with intestinal microbial agents. Based on the results of existing microbiological, molecular, and immunological studies, Klebsiella microbe seems to have a key role in the initiation and perpetuation of the pathological damage involving the gut and joint tissues in patients with CD. Six different gastroenterology centres in the UK have reported elevated levels of antibodies to Klebsiella in CD patients. There is a relationship between high intake of starch-containing diet, enhanced growth of gut microbes, and the production of pullulanases by Klebsiella. It is proposed that eradication of these microbes by the use of antibiotics and low starch diet, in addition to the currently used treatment, could help in alleviating or halting the disease process in CD. 1. Introduction Crohn’s disease (CD) is a chronic, progressive, and potentially disabling disease, characterised by relapsing and remitting episodes of transmural inflammation of the gastrointestinal tract which might be associated with arthritic manifestations [1]. Both CD and ulcerative colitis (UC) can be categorized under the name of inflammatory bowel disease (IBD). The differentiation between UC and CD is mainly based on clinical manifestations and the scale of bowel involvements. Patients with either CD or UC, however, are likely to have associated extraintestinal manifestations [2]. IBD is classified as one of the constituents of a group of diseases collectively termed spondyloarthropathies (SpAs). The other entities of this group include ankylosing spondylitis (AS), reactive arthritis, psoriatic arthropathy, and undifferentiated SpA [3]. There are certain features frequently associated with this group of diseases and these include spinal/sacroiliac arthritis, oligoarthritis, enthesitis, uveitis, negativity for rheumatoid factors, and a positive family history. A positive family history and a high degree of association of SpAs with HLA-B27 genetic markers have placed these conditions under the umbrella of what is called “B27 diseases” [4]. Furthermore, patients with CD seem to share more genetic, clinical, laboratory, immunological, and pathological features with AS patients [5–7]. CD is a relatively common condition involving millions of people all around the world. It usually affects a younger age group with a worldwide distribution. It has a high impact on the psychological condition [8], as well as the social status and work abilities [9] in patients with
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