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Inflammatory bowel disease in spondyloarthritis - does it matter?

Extra-musculoskeletal manifestations (EMMs) occur in patients with spondyloarthritis.

The prevalence of EMMs such as uveitis, psoriasis and inflammatory bowel disease are 26%, 9% and 7% respectively in axial spondyloarthritis (axSpA). The prevalence of subclinical inflammatory bowel disease (IBD) is higher at 50% when screening was done by ileocolonoscopy and biopsy or endoscopic capsule, showing a 10 fold higher co-existence between IBD and axSpA. On the other side, up to 50% of patients with IBD present with extraintestinal manifestations including arthralgia and musculoskeletal symptoms prior to the IBD diagnosis.

Do the clinical features of axSpA patients with and without IBD differ?

In Abstract OP0085 at #EULAR2024, De Hooge M et al presented data from the METEOR cohort that identify clinical differences between these two groups. This will be important in order to stratify the management approach in axSpA patients with or without IBD as the emerging therapies have different effects on EMMs.

Using the METEOR SpA database, this study stratified patients based on the presence or absence of IBD. In this cohort, 7% of patients had concomitant IBD with a mean symptom duration of 12 years. The worldwide prevalence of IBD was 1-20%. In SpA patients with IBD, the features were being older, more often female (although male predominance persisted), higher BMI, higher BASFI, longer disease duration, lower HLA-B27 and psoriasis. There was a higher prevalence of IBD. There was no difference in the prevalence of dactylitis or enthesitis between both groups. Disease activity was equal in both groups although patients with IBD had more structural change seen in the SI joints. In the peripheral SpA group, the patients with IBD were younger, had less psoriasis, more uveitis and had a higher physician global.

As we move towards a stratified approach in treating axSpA, in patients with concomitant IBD, we should also consider how treatments will also cover other associated EMMs such as uveitis. For example in the axSpA group, the clinical features could be older+axSpA+IBD+uveitis. In the peripheral SpA, one combination could be younger+axSpA+IBD+uveitis. Many more combinations could be developed using additional information such outcome measures eg. ASDAS and also radiographic data which will help with making choices with the emerging therapies in axSpA.


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