scholarly journals Examining spondyloarthritis in patients with inflammatory bowel disease

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.

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

2013 ◽  
Vol 40 (10) ◽  
pp. 1726-1735 ◽  
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.

Reactive arthritis and enteropathic arthropathy

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.

Reactive arthritis and enteropathic arthropathy

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.

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

2017 ◽  
Vol 11 (suppl_1) ◽  
pp. S160-S160 ◽  
Author(s):  
E. Belousova ◽  
D. Abdulganieva ◽  
A. Odintsova ◽  
R. Zakirov ◽  
B. Nagornykh ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Back Pain ◽  
Bowel Disease ◽  
Inflammatory Back Pain ◽  
Asas Criteria ◽  
Inflammatory Bowel

scholarly journals POS0035 ONE IN TWENTY INFLAMMATORY BOWEL DISEASE PATIENTS WHO UNDERWENT ABDOMINOPELVIC COMPUTED TOMOGRAPHY HAVE UNDIAGNOSED AXIAL SPONDYLOARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 223.1-223
Author(s):  
C. S. E. Lim ◽  
L. Hamilton ◽  
S. Low ◽  
A. Toms ◽  
A. Macgregor ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Inflammatory Bowel Disease ◽  
Back Pain ◽  
Bowel Disease ◽  
Screening Tool ◽  
Chronic Back Pain ◽  
Axial Spondyloarthritis ◽  
Research Support ◽  
Abdominopelvic Ct ◽  
Inflammatory Bowel

Background:The diagnosis of axial spondyloarthritis (axSpA) is challenging and hindered by delay. There may be an opportunity to identify sacroiliitis for further rheumatology review in inflammatory bowel disease (IBD) patients who undergo Computed Tomography (CT) for non-musculoskeletal (MSK) indications.Objectives:To identify what proportion of IBD patients who underwent abdominopelvic CT for non-MSK indications have axSpA and to explore the role of an imaging strategy for identifying axSpA.Methods:Abdominopelvic CT scans of verified IBD patients were identified retrospectively from eight years of imaging archive. Patients between 18-55 yrs. were selected as having the highest diagnostic yield for axSpA. CT review (using criteria from a validated CT screening tool developed by Chan1) was undertaken by a trained radiology team for presence of CT-defined sacroiliitis (CTSI). All CTSI patients were sent a screening questionnaire. Those with self-reported chronic back pain (CBP), duration > 3 months, onset < 45 years were invited for rheumatology review. This included a medical interview, physical examination (joint count, MASES, dactylitis count, BASMI), patient reported outcomes (BASDAI, BASFI, BASGI, Harvey-Bradshaw-Index, Partial-Mayo-Index), relevant laboratory tests (CRP, ESR, HLA-B27), axSpA protocol MRI, and remote review by a panel of experienced rheumatologists with a special interest in axSpA.Results:CTSI was identified in 60 of 301 patients. Thirty-two (53%) responded to the invitation to participate and 27 (84%) were enrolled. Of these, eight had a pre-existing axSpA diagnosis and five did not report chronic back pain. Fourteen patients underwent rheumatological assessment; three of 14 (21.4% [95% CI: 4.7%, 50.8%]) had undiagnosed axSpA. In total, 11 of 27 (40.7% [95% CI: 22.4%, 61.2%]) patients had a rheumatologist verified diagnosis of axSpA.Conclusion:One in five patients (60/301) with IBD who underwent abdominopelvic CT for non-MSK indications have CTSI and at least one in five (11/60) have axSpA. Five percent (3/60) were previously undiagnosed. This highlights a hidden disease burden and a potential strategy for identifying new cases.References:[1]Chan J, Sari I, Salonen D, Inman RD, Haroon N. Development of a Screening Tool for the Identification of Sacroiliitis in Computed Tomography Scans of the Abdomen. J Rheumatol 2016; 43(9); 1687-94.Acknowledgements:We are indebted to Baljeet Dhillon and Shin Azegami for their assistance in the scoring of the CTSI.Disclosure of Interests:Chong Seng Edwin Lim Grant/research support from: AbbVie, Louise Hamilton: None declared, Samantha Low: None declared, Andoni Toms: None declared, Alex MacGregor: None declared, Karl Gaffney Speakers bureau: AbbVie, Eli Lilly, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, UCB Pharma, Grant/research support from: AbbVie, Gilead, Eli Lilly, Novartis, UCB Pharma.

scholarly journals Prevalence of axial spondyloarthritis in patients with inflammatory bowel disease using cross-sectional imaging: a systematic literature review

2021 ◽  
Vol 13 ◽  
pp. 1759720X2199697
Author(s):  
Jobie Evans ◽  
Mark Sapsford ◽  
Scott McDonald ◽  
Kenneth Poole ◽  
Tim Raine ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Axial Spondyloarthritis ◽  
Inflammatory Back Pain ◽  
Sample Sizes ◽  
Cross Sectional ◽  
Significant Difference ◽  
Cross Sectional Imaging ◽  
Inflammatory Bowel ◽  
Sectional Imaging

Background: Patients with inflammatory bowel disease (IBD) have an excess burden of axial spondyloarthritis (axSpA), which, if left untreated, may significantly impact on clinical outcomes. We aimed to estimate the prevalence of axSpA, including previously undiagnosed cases, in IBD patients from studies involving cross-sectional imaging and identify the IBD features potentially associated with axSpA. Methods: PubMed, Embase and Cochrane databases were searched systematically between 1990 and 2018. Article reference lists and key conference abstract lists from 2012 to 2018 were also reviewed. All abstracts were reviewed by two authors to determine eligibility for inclusion. The study inclusion criteria were (a) adults aged 18 years or above, (b) a clinical diagnosis of IBD and (c) reporting identification of sacroiliitis using cross-sectional imaging. Results: A total of 20 observational studies were identified: 12 used CT, 6 used MR and 2 utilised both computed tomography (CT) and magnetic resonance (MR) imaging. Sample sizes ranged from 25 to 1247 (a total of 4096 patients); 31 studies were considered to have low selection bias, 13 included two or more radiology readers, and 3 included rheumatological assessments. The prevalence of sacroiliitis, the most commonly reported axSpA feature, ranged from 2.2% to 68.0% with a pooled prevalence of 21.0% [95% confidence interval (CI) 17–26%]. Associated IBD features include increasing IBD duration, increasing age, male sex, IBD location, inflammatory back pain and peripheral arthritis. No significant difference in the prevalence of sacroiliitis between Crohn’s disease and ulcerative colitis was identified. Study limitations include variability in the individual study sample sizes and patient demographics. Conclusion: This review highlights the need for larger, well-designed studies using more sensitive imaging modalities and multivariable modelling to better estimate the prevalence of axSpA in IBD. An improved knowledge of the IBD phenotype(s) associated with axSpA and use of cross-sectional imaging intended for IBD assessment to screen for axSpA may help clinicians identify those patients most at risk.

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

2019 ◽  
Vol 50 (11-12) ◽  
pp. 1204-1213 ◽  
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

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

2013 ◽  
Vol 27 (4) ◽  
pp. 199-205 ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document