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

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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Venous thromboembolism in patients with inflammatory bowel disease : review of literature and practical algorithms

Acta Gastro Enterologica Belgica ◽

10.51821/84.1.910 ◽

2021 ◽

Vol 84 (1) ◽

pp. 79-85

Author(s):

L Coremans ◽

B Strubbe ◽

H Peeters

Keyword(s):

Inflammatory Bowel Disease ◽

Venous Thromboembolism ◽

Bowel Disease ◽

Treatment Duration ◽

Mortality Rates ◽

Review Of Literature ◽

Pharmacological Prophylaxis ◽

Practical Algorithms ◽

Younger Age ◽

Inflammatory Bowel

Inflammatory bowel disease (IBD) is associated with several extra-intestinal complications, including venous thromboembolism (VTE). In patients with IBD, VTE occurs at younger age and is associated with higher recurrence and mortality rates as compared to patients without IBD. The risk appears to be higher during active disease and hospitalization. In this review we target the importance of prophylaxis and aim to describe strategies for treatment of VTE in patients with IBD. More awareness is needed, given the fact that VTE is often preventable with appropriate pharmacological prophylaxis. Algorithms are provided on which patients should be given prophylaxis and on treatment duration of VTE in patients with inflammatory bowel disease.

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Examining spondyloarthritis in patients with inflammatory bowel disease

Proceedings of IMPRS ◽

10.18060/24548 ◽

2020 ◽

Vol 3 ◽

Author(s):

Catherine Burns ◽

Reem Jan

Keyword(s):

Inflammatory Bowel Disease ◽

Back Pain ◽

Bowel Disease ◽

Axial Spondyloarthritis ◽

Joint Disease ◽

Inflammatory Back Pain ◽

Gastrointestinal Manifestations ◽

Inflammatory Bowel ◽

Patient Responses ◽

Peripheral Spondyloarthritis

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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Expert consensus paper on the use of Vedolizumab for the management of patients with moderate-to-severe Inflammatory Bowel Disease

Digestive and Liver Disease ◽

10.1016/j.dld.2015.12.016 ◽

2016 ◽

Vol 48 (4) ◽

pp. 360-370 ◽

Cited By ~ 23

Author(s):

Alessandro Armuzzi ◽

Paolo Gionchetti ◽

Marco Daperno ◽

Silvio Danese ◽

Ambrogio Orlando ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Expert Consensus ◽

Consensus Paper ◽

Inflammatory Bowel

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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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