Spondyloarthritis in Early Crohn's Disease Save

Analysis of a German Crohn's disease cohort finds that in patients with early Crohn’s disease (CD), spondyloarthritis (SpA) was present in nearly one out of five patients and was associated with HLA-B27 positivity and a highly active CD.

CD (biologics naive) patients were recruited as a subgroup of the German Spondyloarthritis Inception Cohort (GESPIC-Crohn).  These GI patients were assessed by a rheumatologists using a structured assessment of SpA manifestations, including MRI of sacroiliac joints and spine.

A total of 103 CD patients were enrolled with relatively early CD (disease duration 1.3 ± 2.4 years).  SpA symptoms were frequently found, including back pain (65%), chronic back pain (51%), and arthralgia (44%).

Prevalence of SpA was 19.4% with more axial SpA than peripheral SpA, and more radiographic axial SpA (7.4%) than non-radiographic axial SpA (2.8%).

MRI evidence of axial SpA was found in 15% patients, 81% of whom met criteria for a clinical diagnosis of axial SpA.  Spondyloarthritis among these CD patients was more likely with HLA-B27 positivity (OR 9.02; 2.29 – 35.55) and greater CD disease activity (OR 1.14, 1.01- 1.30).

Rheumatologists and gastroenterologists need to be aware of the frequent concomitance between both diseases to reduce delays in diagnosing SpA.