Screening of silent inflammatory bowel disease in seronegative spondyloarthritis patients: Fecal calprotectin, ileo-colonoscopy and histopathology assessment

Abstract

IntroductionSeronegative spondyloarthritis (SpA) patients are at an increased risk of developing silent inflammatory bowel disease (IBD). Early diagnosis may help avoid future complications and choose the most effective treatment. Aimof the workto screen for silent IBD in SpA patients. Patients and methodsThis study included 41 SpA patients subjected to clinical assessment regarding gastrointestinal symptoms, laboratory data and ileo-colonoscopy with tissue histopathology.Fecal calprotectin levels were measured by enzyme linked-immunosorbant assay (ELISA). The Bath ankylosing spondylitis disease activity index (BASDAI) and psoriatic arthritis disease activity score (PASDAS) were assessed. ResultsThe median age of patients was 40 years (23–58 years) with 27 males and 14 females (M: F 1.9:1); 28 had axial SpA and 13 psoriatic arthritis (PsA); 25 (61%) patients were active. Only 19.5% received non-steroidal anti-inflammatory drugs (NSAIDs) while 61% received biologics. Median fecal calprotectin was 88 mcg/g and was elevated in 71% of patients. Patients receiving biologics had significantly lower median levels of fecal calprotectin than those who did not (72.7 vs 436.7mcg/g; p = 0.012). Abnormal colonoscopy was seen in 14.6% of patients (three Crohn’s disease and three ulcerative colitis). 17 (41.5%) showed abnormal histopathology; 9 had moderate colitis and activity while five patients had moderate colitis with minimal activity. There was a significant relation between platelet count and abnormal colonoscopy findings (p = 0.01). ConclusionSpA patients can have macroscopic or microscopic silent IBD changes. Fecal calprotectin may be used for screening of silent IBD among those patients, however, it should be supported by ileo-colonoscopic examination and histopathological assessment.