Frequency of Spondyloarthritis Symptoms Among U.S. Patients with Inflammatory Bowel Disease: A Cross-sectional Multi-Center Study
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Abstract
Objective
Spondyloarthritis (SpA) is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). The application of screening tools to detect SpA in patients with IBD may lead to earlier recognition of SpA and affect treatment decisions.
Methods
A combination of two previously described SpA screening questionnaires, DETAIL and IBIS-Q, was administered to consecutive patients with IBD attending IBD specialty clinics in six U.S. academic medical centers. Demographic data, IBD and rheumatology history were extracted by chart review.
Results
A total of 669 patients were analyzed. The median age was 40 years (IQR 30 - 54) with a median disease duration of 12 years (IQR 6 - 22) and moderate to severe IBD based on medication exposure and history of bowel surgery. 81 patients (12%) carried a diagnosis of an inflammatory rheumatic disease while 75 (11%) had consulted a rheumatologist during the previous year. Using published cutoffs, 180 out of 669 patients (27%) screened positive with DETAIL, 266 (40%) with IBIS-Q and 275 (41%) with either questionnaire. Axial symptoms were more frequently reported than peripheral musculoskeletal complaints. Notably, 189 out of 275 (69%) screen-positive patients, had neither a documented inflammatory rheumatic disease diagnosis nor a visit with a rheumatologist within the past year.
Conclusion
A substantial proportion of patients with IBD have symptoms suggestive of SpA, and many of these may have undiagnosed SpA. The IBIS-Q questionnaire appears to identify more potential SpA cases than DETAIL. Strategies are needed to prioritize rheumatology consultations for those patients with IBD who are most likely to benefit.
