Finding Spondylitis Among Psoriasis, Uveitis and Colitis Patients Save

Maksymowych and colleagues have shown that screening patients with either psoriasis, iritis, or colitis may yield a surprising percentage meeting ASAS criterial for axial spondyloarthritis (axSpA).

The Screening in Axial Spondyloarthritis in Psoriasis, Iritis, Colitis, (SASPIC) study enrolled two cohorts of consecutive patients with undiagnosed chronic back pain attending dermatology, ophthalmology, and gastroenterology clinics. 

Patients with psoriasis (PsO), acute anterior uveitis (AAU), or inflammatory bowel disease (IBD) were referred to an axSpA-experienced rheumatologist for an evaluation, that included clinical, lab (CRP and HLA-B27) and imaging assessments. Imaging included radiographs and MRI (if necessary). SI MRI was done in 2/3 of SASPIC-1 and all of SASPIC-2 patients. 

The primary outcome was proportion of patients diagnosed with axSpA according to 2009 ASAS classification criteria.

SASPIC-1 cohort included 212 patients (21% PsO, 34% AAU, 44% IBD) and the SASPIC-2 cohort included 151 patients (34% PsO, 38% AAU, 28% IBD). The percentage diagnosed with axSpA (per site) varied from 15.8-100% inSASPIC-1 and from 20-71.4% in SASPIC-2.

The pecentage of axSpA patients found among PsO, AAU and IBD patients followed in dermatology, ophthalmology and GI clinics is shown in the table below.

Axial Spondyloarthritis in PsO, AAU and IBD patients

In the first cohort, MRI indicated axSpA in 60-80%. All patients had MRI in SASPIC-2; this led to 25% fewer diagnoses of axSpA in HLA B27 negative PsO and IBD patients.

Patients with PsO, AAU, IBD, and undiagnosed chronic back pain should be referred rheumatologists for consideration of an axSpA diagnosis.