AB0875 Assessment of Clinical Signs of Spondyloarthritis in Patients with Inflammatory Bowel Disease

Abstract

BackgroundPatients with inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), commonly face the presence of extraintestinal manifestations (EIMs). Spondyloarthritis (SpA) is present in about 10-39% of patients with IBD, being the most frequent EIM [1]. Diagnosis of axial SpA (axSpA) in IBD represents a clinical challenge. The diagnostic value of Ankylosing Spondylitis Assessment Society (ASAS) criteria that are used for defining inflammatory back pain (IBP) in axSpA, in patients with the association of axSpA and IBD is not clear.ObjectivesTo determine the diagnostic value of ASAS criteria for IBP (2009) and to evaluate factors that are associated with a higher risk of axial SpA in patients with IBD.MethodsThe study included 91 patients with IBD (UC - 52 patients (57.1%), CD - 39 (42.9%), males – 47 (51.6%), mean age 40.2±11.7 years, duration of IBD – 7.7±7.6 years). IPB was defined by ASAS criteria (2009). AxSpA in patients with IBD is recommended to be diagnosed by the combination of Inflammatory Back Pain (IBP), and imaging (MRI and X-ray) [2]. Imaging of lumbar spine and sacroiliac joints was performed to patients, who fulfilled the ASAS criteria for IBP: X-ray - 55 patients; MRI (T1, STIR) - 41 patients. Imaging was considered positive when patients had at least unilateral sacroiliitis stage 2 or higher according to the accepted grading system on X-Ray, or MRI-verified sacroiliitis.ResultsLow back pain was observed in 84 (92.3%) patients with IBD, 39 (42.9%) patients fulfilled the criteria ASAS for IBP. MRI-verified sacroiliitis was present in 26 patients. Changes on X-ray were present in 40 patients. After imaging, 26 patients were diagnosed with axSpA, 14 of them fulfilled the modified New York criteria for the ankylosing spondylitis. Diagnostic value of the ASAS criteria was the following: sensitivity 76.9%, specificity 67.2%, PPV 0.51, NPV 0.87, LR+ 2.3, and LR- 0.3 (ECCO consensus definition used as the “gold standard”). Presence of arthritis - OR 10.77 [95% CI 2.26-44.2], p=0.005, arthralgia - OR 4.12 [95% CI 1.55-10.95], p=0.005, CD - OR 2.92 [95% CI 1.14-7.48], p=0.025 and IBP – OR 8.07 [95% CI 2.8-23.23], p=0.001 was associated with a higher risk of axSpA diagnosis in the univariate logistic regression model. The associations remained statistically significant when multivariate logistic regression model was constructed – arthritis 20.03 [95% CI 3.05 -131.69], CD – 3.51 [95% CI 1.04-11.82], IBP – 8.72 [95% CI 2.64-28.79], R2=0.486.ConclusionThe ASAS criteria for IBP had a good diagnostic value in patients with IBD. The diagnostic value of the ASAS criteria for IBP (2009) in patients with IBD was comparable to the following in the patients with chronic back pain. Clinicians should pay attention to the presence of arthritis, arthralgia, IBP and CD, as these factors were associated with a higher risk of being diagnosed with axSpA in patients with IBD.