P588 Evolution and management of inflammatory joint pathology with non-anti-TNF therapies in inflammatory bowel disease

Abstract

Abstract Background The role of ustekinumab (UST) and vedolizumab (VDZ) in articular extra-intestinal manifestations of IBD remains unclear and most existing studies are retrospective. The aim of this study is to analyze the incidence of new onset or worsening of a preexisting IBD-associated arthropathy in patients treated with UST and VDZ. Methods An observational prospective study in a tertiary care University hospital was conducted. IBD patients undergoing treatment with VDZ or UST with previous spondyloarthritis (SpA) or new onset arthropathy were included. Articular manifestations were evaluated by a rheumathologist within 72 hours. IBD and rheumatological related variables were assessed at baseline and after 6 months, including demographics, clinical, biochemical, endoscopic and ultrasound data. Results 201 patients were on treatment with UST and VDZ. Of these, 80 were referred to rheumatology for previous SpA or symptoms onset. 56 (70%) with VDZ and 24 (30%) with UST. 24 (30%) of them were classified as SpA: 22 (92%) had a previous diagnosis and 2 (8%) debuted during treatment with VDZ or UST. The remaining 56 (70%) were diagnosed with other rheumatological pathologies. Type of arthritis was: peripheral arthritis, 11 (46.4%); axial, 7 (29%) and mixed, 6 (25%). Most patients had received 1 or 2 biological therapies (73%), 90% of them were anti-TNF experienced. 48% of patients received UST or VDZ in monotherapy, without disease-modifying antirheumatic drugs (DMARDs). The most frequent type of arthritis in patients with previous SpA was peripheral (50% peripheral only and 18% mixed). Joint activity remained stable or even improved in these patients. Only 2 (9%) had axial disease flare-up, one with UST and one with VDZ. Both patients had moderate intestinal activity (C-reactive protein; CRP > 2.5 mg/dl and faecal calprotectin; FC > 600 ug/g). Treatment was not discontinued in any case.SpA debuted in 2 patients with mixed arthritis on treatment with VDZ. Both patients also had poor IBD control (CRP > 3.5 mg/dl and CF > 600 ug/g). A change of biologic therapy was performed in addition to adjusting treatment with concomitant DMARDs. Conclusion In our experience, treatment with UST and VDZ did not worsen joint pathology in patients with SpA. Most of them remained stable or improved. Patients with joint flare-ups also had poor control of bowel activity, which could be the main cause of worsening SpA.