P163 Performance of ASAS criteria for inflammatory back pain in patients with inflammatory bowel disease

Background/Objective: Axial spondyloarthritis refers to a syndrome of inflammatory back pain associated with radiographic or magnetic resonance imaging abnormalities. Peripheral spondyloarthritis can include dactylitis, enthesitis or oligo-arthritis. Together these encompass common extra-gastrointestinal manifestations of inflammatory bowel disease (IBD), with the prevalence of ankylosing spondylitis estimated to be about 3% in patients with IBD and unspecified sacroiliitis occurring in 10%. The goals of this study are to validate the accuracy of the Toronto Axial Spondyloarthritis Questionnaire in identifying patients with rheumatologic symptoms in the context of IBD, to re-evaluate the prevalence of spondyloarthritis in this population, and to identify any differences in referral rate between racial and ethnic groups. Methods: Patients were selected based on the following criteria: diagnosis of IBD, upcoming appointment with their gastroenterologist, prior consent in the Genesys database and access to an operational MyChart account. Patients were sent a link and asked to complete a RedCap survey modified from the Toronto Axial Spondyloarthritis Questionnaire. Positive patient responses will be analyzed in a follow-up visit with a rheumatologist to investigate the patients’ symptoms. Results: At present, the survey was sent to 86 patients with 26 respondents completing the survey. Of the respondents, 6 patients had experienced back pain for a duration of 3 months or longer. Eleven patients had pain and swelling of a joint unrelated to injury. Seven patients experienced pain and swelling of an entire finger or toe unrelated to injury. Seven patients experienced heel pain unrelated to injury. One patient is followed by rheumatology. Conclusion/Potential Impact: Major extra gastrointestinal manifestations of IBD include axial or peripheral spondyloarthritis which can lead to disabling back pain and/ or joint disease. With the modified Toronto Axial Spondyloarthritis Questionnaire, gastroenterologists could have a better way to identify concerning symptoms, leading to increased referral to rheumatologists and potential changes in treatment plans.

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Reactive arthritis and enteropathic arthropathy

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0115_update_005 ◽

2013 ◽

pp. 901-910

Author(s):

J. S. Hill Gaston

Keyword(s):

Inflammatory Bowel Disease ◽

Back Pain ◽

Bowel Disease ◽

Reactive Arthritis ◽

Inflammatory Back Pain ◽

Hla B27 ◽

Genetic Studies ◽

Inflammatory Bowel ◽

Disease Modifying ◽

Crystal Induced Arthritis

Reactive arthritis (ReA), and enteropathic arthritis secondary to inflammatory bowel disease, are forms of spondyloarthritis, all of which share an association with HLA B27 and can involve both axial and peripheral joints. Genetic studies strongly implicate the cytokines IL-17 and IL-23 in their pathogenesis, and evidence for autoimmunity is lacking. ReA is triggered by particular bacteria, mainly affecting the gut and genitourinary tract, though infections are sometimes asymptomatic. Classically an acute oligo- or monoarthritis with enthesitis occurs, often with inflammatory back pain, though mild polyarthritis can also occur. Septic and crystal-induced arthritis are the principal differential diagnoses. Extra-articular features may aid diagnosis, which otherwise requires laboratory evidence of preceding infection. Bacterial components traffic to the joint (which is nevertheless sterile), and elicit local pro-inflammatory immune responses. Most ReA is self-limiting, but persistent cases may require disease-modifying anti-rheumatic drugs or even biologics.

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Reactive arthritis and enteropathic arthropathy

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0115_update_003 ◽

2013 ◽

pp. 901-910

Author(s):

J. S. Hill Gaston

Keyword(s):

Inflammatory Bowel Disease ◽

Back Pain ◽

Bowel Disease ◽

Reactive Arthritis ◽

Inflammatory Back Pain ◽

Hla B27 ◽

Genetic Studies ◽

Inflammatory Bowel ◽

Disease Modifying ◽

Crystal Induced Arthritis

Reactive arthritis (ReA), and enteropathic arthritis secondary to inflammatory bowel disease, are forms of spondyloarthritis, all of which share an association with HLA B27 and can involve both axial and peripheral joints. Genetic studies strongly implicate the cytokines IL-17 and IL-23 in their pathogenesis, and evidence for autoimmunity is lacking. ReA is triggered by particular bacteria, mainly affecting the gut and genitourinary tract, though infections are sometimes asymptomatic. Classically an acute oligo- or monoarthritis with enthesitis occurs, often with inflammatory back pain, though mild polyarthritis can also occur. Septic and crystal-induced arthritis are the principal differential diagnoses. Extra-articular features may aid diagnosis, which otherwise requires laboratory evidence of preceding infection. Bacterial components traffic to the joint (which is nevertheless sterile), and elicit local pro-inflammatory immune responses. Most ReA is self-limiting, but persistent cases may require disease-modifying anti-rheumatic drugs or even biologics.

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Expert consensus: practical algorithms for management of inflammatory bowel disease patients presenting with back pain or peripheral arthropathies

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.15519 ◽

2019 ◽

Vol 50 (11-12) ◽

pp. 1204-1213 ◽

Cited By ~ 4

Author(s):

Gaëlle Varkas ◽

Clio Ribbens ◽

Edouard Louis ◽

Filip Van den Bosch ◽

Rik Lories ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Back Pain ◽

Bowel Disease ◽

Expert Consensus ◽

Practical Algorithms ◽

Inflammatory Bowel

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Prevalence of Self-Reported Spondyloarthritis Features in a Cohort of Patients with Inflammatory Bowel Disease

Canadian Journal of Gastroenterology ◽

10.1155/2013/139702 ◽

2013 ◽

Vol 27 (4) ◽

pp. 199-205 ◽

Cited By ~ 34

Author(s):

Carmen Stolwijk ◽

Marieke Pierik ◽

Robert Landewé ◽

Ad Masclee ◽

Astrid van Tubergen

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Musculoskeletal Symptoms ◽

Inflammatory Back Pain ◽

Early Referral ◽

History Of ◽

Seronegative Spondyloarthritis ◽

Inflammatory Bowel ◽

Inflammatory Drugs ◽

Or History

BACKGROUND: Musculoskeletal symptoms belonging to the spectrum of ‘seronegative spondyloarthritis’ (SpA) are the most common extraintestinal manifestations in patients with inflammatory bowel disease (IBD) and may lead to important disease burden. Patients with suspected SpA should be referred to a rheumatologist for further evaluation.OBJECTIVE: To investigate the self-reported prevalence of musculoskeletal SpA features in a cohort of patients with IBD and to compare this with actual referrals to a rheumatologist.METHODS: Consecutive patients with IBD visiting the outpatient clinic were interviewed by a trained research nurse about possible SpA features using a standardized questionnaire regarding the presence or history of inflammatory back pain, peripheral arthritis, enthesitis, dactylitis, psoriasis, uveitis and response to nonsteroidal anti-inflammatory drugs. All patient files were verified for previous visits to a rheumatologist and any rheumatic diagnosis.RESULTS: At least one musculoskeletal SpA feature was reported by 129 of 350 (36.9%) patients. No significant differences between patients with Crohn disease and ulcerative colitis were found. Review of medical records showed that 66 (51.2%) patients had ever visited a rheumatologist. Axial SpA was diagnosed in 18 (27.3%) patients, peripheral SpA in 20 (30.3%) patients and another rheumatic disorder in 14 (21.2%) patients.CONCLUSION: Musculoskeletal SpA features are frequently present in patients with IBD. However, a substantial group of patients is not evaluated by a rheumatologist. Gastroenterologists play a key role in early referral of this often debilitating disease.

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Reactive arthritis and enteropathic arthropathy

10.1093/med/9780199642489.003.0115_update_002 ◽

2016 ◽

Author(s):

J. S. Hill Gaston

Keyword(s):

Inflammatory Bowel Disease ◽

Back Pain ◽

Immune Responses ◽

Reactive Arthritis ◽

Inflammatory Back Pain ◽

Hla B27 ◽

Genetic Studies ◽

Inflammatory Bowel ◽

Disease Modifying ◽

Crystal Induced Arthritis

Reactive arthritis (ReA), and enteropathic arthritis secondary to inflammatory bowel disease, are forms of spondyloarthritis, all of which share an association with HLA B27 and can involve both axial and peripheral joints. Genetic studies strongly implicate the cytokines IL-17 and IL-23 in their pathogenesis, and evidence for autoimmunity is lacking. ReA is triggered by particular bacteria, mainly affecting the gut and genitourinary tract, though infections are sometimes asymptomatic. Classically an acute oligo- or monoarthritis with enthesitis occurs, often with inflammatory back pain, though mild polyarthritis can also occur. Septic and crystal-induced arthritis are the principal differential diagnoses. Extra-articular features may aid diagnosis, which otherwise requires laboratory evidence of preceding infection. Bacterial components traffic to the joint (which is nevertheless sterile), and elicit local pro-inflammatory immune responses. Most ReA is self-limiting, but persistent cases may require disease-modifying anti-rheumatic drugs or even biologics.

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Spondyloarthritis in a Patient With Unilateral Buttock Pain and History of Crohn Disease

Physical Therapy ◽

10.2522/ptj.20090172 ◽

2010 ◽

Vol 90 (5) ◽

pp. 784-792 ◽

Cited By ~ 6

Author(s):

Rogelio A. Coronado ◽

Charles Z. Sheets ◽

Chad E. Cook ◽

William G. Boissonnault

Keyword(s):

Inflammatory Bowel Disease ◽

Physical Therapy ◽

Bowel Disease ◽

Specific Treatment ◽

Medical Intervention ◽

Inflammatory Back Pain ◽

Buttock Pain ◽

History Of ◽

Inflammatory Bowel ◽

Primary Care Practitioners

Background and Purpose Patients with inflammatory spinal conditions related to spondyloarthritis are rarely seen by primary care practitioners. However, patients with a history of inflammatory bowel disease and chronic low back or buttock pain should be examined carefully for the presence of spondyloarthritis, as proper management may include referral to a rheumatologist and appropriate medical intervention. Case Description A 27-year-old woman with a 6-month history of posterior buttock pain was referred for physical therapy with a diagnosis of piriformis syndrome. During the second physical therapy visit, a nonmechanical source of lumbopelvic pain was suspected, and the patient was referred for medical consultation. The patient underwent evaluation by a rheumatologist and was eventually diagnosed with spondyloarthritis associated with inflammatory bowel disease. Outcomes The patient initiated treatment with anti-tumor necrosis factor medication to address the spondyloarthritis. Medical management resulted in significant improvement in all outcome measures. Discussion Clinical suspicion of spondyloarthritis is raised when specific historical, examination, and imaging findings are present. The posttest probability of spondyloarthritis is increased with the presence of inflammatory back pain and specific spondyloarthritic features, such as a positive history of inflammatory bowel disease, radiographic evidence of sacroiliitis, and improvement with anti-inflammatory medication. Referral of patients with these findings for a rheumatological evaluation is warranted, as these diseases are managed effectively with specific treatment.

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Development, Sensibility, and Reliability of the Toronto Axial Spondyloarthritis Questionnaire in Inflammatory Bowel Disease

The Journal of Rheumatology ◽

10.3899/jrheum.130048 ◽

2013 ◽

Vol 40 (10) ◽

pp. 1726-1735 ◽

Cited By ~ 12

Author(s):

Khalid A. Alnaqbi ◽

Zahi Touma ◽

Laura Passalent ◽

Sindhu R. Johnson ◽

George A. Tomlinson ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Back Pain ◽

Bowel Disease ◽

Chronic Back Pain ◽

Axial Spondyloarthritis ◽

Face Validity ◽

Delay In Diagnosis ◽

Inflammatory Bowel ◽

Absolute Agreement ◽

Kappa Agreement

Objective.There is an unacceptable delay in the diagnosis of axial spondyloarthritis (axSpA) in its early stages among patients at high risk, in particular those with inflammatory bowel disease (IBD). Our objectives were to develop a sensible and reliable questionnaire to identify undetected axSpA among patients with IBD.Methods.Literature was reviewed for item generation in the Toronto axSpA Questionnaire on IBD (TASQ-IBD). Sensibility of the questionnaire was assessed among healthcare professionals and patients. This assessment was related to purpose and framework (clinical function, clinical justification, and clinical applicability), face validity, comprehensiveness [oligo-variability (limiting the questionnaire to important items) and transparency], replicability, content validity, and feasibility. The test-retest reliability study was administered to 77 patients with established IBD and axSpA. Kappa agreement coefficients and absolute agreement were calculated for items.Results.Three domains included IBD, inflammatory back symptoms, and extraaxial features. The entry criterion required a patient to have IBD and back pain or stiffness that ever persisted for ≥ 3 months. Iterative sensibility assessment involved 16 items and a diagram of the back. Kappa coefficients ranged from 0.81–1.00 for each item. Absolute agreement across all items ranged from 91% to 100%.Conclusion.TASQ-IBD is a newly developed, sensible, and reliable case-finding questionnaire to be administered to patients with IBD who have ever had chronic back pain or stiffness persisting for ≥ 3 months. It should facilitate identification and timely referral of patients with IBD to rheumatologists and minimize the delay in diagnosis of axSpA. Consequently, it should assess the prevalence of axSpA in IBD.

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ASAS criteria for inflammatory back pain: diagnostic significance in patients with inflammatory bowel disease

Rheumatology Science and Practice ◽

10.14412/1995-4484-2019-175-179 ◽

2019 ◽

Vol 57 (2) ◽

pp. 175-179

Author(s):

E. N. Belousova ◽

A. Kh. Odintsova ◽

M. S. Protopopov ◽

D. I. Abdulganieva

Keyword(s):

Back Pain ◽

Likelihood Ratio ◽

International Society ◽

Predictive Value ◽

Chronic Back Pain ◽

Inflammatory Back Pain ◽

Diagnostic Significance ◽

Asas Criteria ◽

Diagnostic Characteristics ◽

Inflammatory Bowel

Damage of peripheral joints and spine is a frequent manifestation of spondyloarthritis associated with inflammatory bowel diseases (IBD). One of the most frequent and typical manifestations of axial spondyloarthritis (axSpA) is inflammatory back pain (IBP), which is determined according to the IBP criteria of the International society for the study of spondyloarthritis (The Assessment of SpondyloArthritis international Society – ASAS) 2009. The diagnosis of axSpA is based on the identification of combination of typical changes in the sacroiliac joints (presence of sacroiliitis according to MRI or radiography) with a characteristic clinical picture. However, the diagnostic significance of these criteria and the possibility of use in patients with IBD and chronic back pain have not been studied.Subjects and methods. The study included 84 patients with IBD and back pain. The mean age of patients was 40.5±11.9 years, the duration of IBD symptoms – 8.11±7.67 years.Results and discussion. In our study, the sensitivity of the ASAS criteria for IBD was 76.9% and specificity – 67.2%, positive predictive value was 0.51, a negative predictive value – 0.87. The likelihood ratio of a positive result is 2.3, the likelihood ratio of a negative result is 0.3.Conclusion. The main diagnostic characteristics of ASAS IBD criteria (2009) for patients with IBD were comparable with those in the population of patients with chronic back pain (sensitivity – 79.6% and specificity – 72.4%).

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P284 Disentangling fibromyalgia from spondyloarthopathy in the patient with inflammatory bowel disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.413 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S294-S294

Author(s):

A Variola ◽

E Bertolini ◽

M Di Ruscio ◽

F Vernia ◽

A Geccherle ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Bowel Disease ◽

Tender Joint Count ◽

Diagnostic Purpose ◽

Acr Criteria ◽

Asas Criteria ◽

Inflammatory Bowel ◽

The Impact

Abstract Background Joint pain is common in subjects affected by Inflammatory bowel disease (IBD) and is linked to several factors including spondyloarthritis (SpA), drug therapy, concomitant osteoarthritis and fibromyalgia (FM). The primary aim of this study was to estimate the prevalence of primary FM and concomitant FM and SpA in a cohort of IBD patients. The secondary aim was to assess the impact of FM on clinimetric scores and ultrasonographic features. Methods Consecutive cases with IBD attending two IBD Units were assessed by a rheumatologist for ASAS criteria for SpA or the 2010 ACR criteria for FM. The rheumatological assessment included a 66 swollen joint count (SJC) and 68 tender joint count (TJC), Maastricht Ankylosing Spondylitis Score (MASES), Leeds Enthesitis Index (LEI) and the FM tender points examination, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). One hundred and fifty-eight patients seen at Reggio Emilia centre underwent US entheseal examination. MRI and HLA-B27 determination were requested if needed for diagnostic confirmation. Results 301 patients were enrolled with 148 completing the clinical and imaging/laboratory assessment if requested for diagnostic purpose. A total of 37 IBD patients (12%) met the ACR criteria for FM: 27 patients (9%) presented the criteria for primary FM and 10 patients (3.3%) presented FM and SpA. Patients who met FM criteria were mostly female (81%, p < 0.001), slightly older, with longer duration of disease; no correlation with smoking, sedentary job, body mass index (BMI) or psoriasis. Of note FM patients presented higher LEI, BASDAI and BASFI scores than SpA patients. At US examination patients who satisfied ASAS criteria for SpA had significantly higher mean enthesis/patient PD positive as compared with IBD and FM group (p < 0.001 for the two comparison) and had more patients with at least one PD positive enthesis (p < 0.001 and p = 0.028 respectively). Acute entheseal lesions had a higher prevalence in the ASAS+ group as compared with the other two groups (p = 0.002 vs. IBD group and p = 0.009 vs. FM group). Chronic entheseal lesions had the same prevalence in the three groups of patients. Conclusion FM is common among IBD patients and more prevalent in females and patients aged ≥ 45 years old. In this subgroup of patients SpA disease activity indices performed poorly for distinguishing patients with disease activity from those with functional impairment. On the contrary, US examination showed a promising discriminating capacity in SpA patients.

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