Association of Diverticulitis with Prolonged Spondyloarthritis: An Analysis of the ASAS-COMOSPA International Cohort.

Mohammad Derakhshan,Raj Sengupta,Jonathan Packham,Anna Molto,Nicola Goodson,Helena Marzo-Ortega,Stefan Siebert,Britspa And The Asas-Comospa Investigators

doi:10.3390/jcm8030281

Abstract

This study examined the relationship between spondyloarthritis (SpA) duration and gastrointestinal comorbidities other than inflammatory bowel disease (IBD). We evaluated the association between SpA duration and upper gastrointestinal ulcers, hepatitis B (HBV), hepatitis C (HCV) and diverticulitis using data from a large international cross-sectional study. Binary regression models were created, adjusted for age, sex, body mass index (BMI), smoking, alcohol, non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), biologics, steroids, IBD history and country. Subgroup analysis was performed by disease phenotype. The data of 3923 participants were analysed. The prevalence of gastrointestinal conditions were 10.7% upper gastrointestinal ulcers; 4.7% viral hepatitis and 1.5% diverticulitis. While SpA duration was not associated with upper gastrointestinal ulcers, HBV or HCV, longer SpA duration was significantly associated with diverticulitis (odds ratios (OR) = 1.18, 95% confidence interval (CI): 1.03–1.34), reflecting an 18% increase for every five years of SpA duration. Other significant associations with diverticulitis were age and high alcohol intake but not medication history. In subgroup analyses, the association was strongest with those with axial SpA. The reasons for this association of increased diverticulitis with disease duration in SpA, especially those with axial disease, are unclear but may reflect shared underlying gut inflammation. Diverticulitis should be considered, in addition to IBD, when SpA patients present with lower gastrointestinal symptoms.

Highlights

Spondyloarthritis (SpA) represents a group of inflammatory rheumatic musculoskeletal disorders with shared pathogeneses, clinical and therapeutic features
We evaluate the association of gastrointestinal conditions with SpA in more detail by exploring the potential associations between the chronology of SpA, “SpA disease duration”, and the prevalence of gastrointestinal comorbidities using data from the Assessment of Spondyloarthritis international Society-COMOrbidities in SPondyloArthritis (ASAS-COMOSPA) study
We found no associations between SpA disease duration and ever diagnosis of either HBV or HCV, suggesting there is no association between SpA and these conditions

Summary

Introduction

Spondyloarthritis (SpA) represents a group of inflammatory rheumatic musculoskeletal disorders with shared pathogeneses, clinical and therapeutic features. Musculoskeletal clinical features consistent with SpA have been reported to occur in up to 13% of patients with IBD [3]. People with SpA are at increased risk of other gastrointestinal effects as a result of their treatments. Upper gastrointestinal ulcers are commonly reported comorbidities, mainly attributed to the chronic intake of non-steroidal anti-inflammatory drugs (NSAIDs) and use of steroids in SpA [6,7], the introduction of selective cox-2 inhibitors and concomitant gastroprotection have relatively declined their incidence [8,9]. The use of tumour necrosis factor (TNF)-blockers in the treatment of SpA is associated with an increased risk of reactivation of latent viral hepatitis [10,11]. Gastrointestinal conditions other than IBD are important comorbidities in SpA, which may contribute to morbidity and have implications for therapeutic decisions in SpA

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