Spondyloarthritis Research Articles

Fibroblast Activation Protein (FAP)-Mediated Cleavage of Type III Collagen Reveals Serum Biomarker Potential in Non-Small Cell Lung Cancer and Spondyloarthritis.

Fibroblast activation protein (FAP) is a known promoter of tumor development and is associated with poor clinical outcome for various cancer types. Being specifically expressed in pathological conditions including multiple types of fibrosis and cancers, FAP is an optimal target for diagnostics and treatment. Treatment strategies utilizing the unique proteolytic activity of FAP are emerging, thus emphasizing the importance of biomarkers to directly assess FAP activity. FAP is a type II transmembrane serine protease that has been shown to cleave collagens and other ECM components. In this study, we developed an ELISA assay (C3F) targeting a circulating type III collagen fragment derived from FAP cleavage to reflect FAP activity. We demonstrated that C3F was specific to the neoepitope of the cleavage site and that the fragment was generated through FAP cleavage of type III collagen. We measured C3F in serum from a cohort of patients with non-small cell lung cancer (NSCLC) (n = 109) matched to healthy subjects (n = 42) and a cohort of patients with spondyloarthritis (SpA) (n = 17) matched to healthy subjects (n = 19). We found that C3F was significantly elevated in patients with NSCLC and in patients with SpA compared to healthy controls (p < 0.0001 and p = 0.0015, respectively). These findings suggest that C3F is a promising non-invasive biomarker reflecting FAP activity, which may aid in understanding tumor heterogeneity and potentially FAP-targeted therapies.

Cervical Vertebrae Internal Fixation Revision in a Patient with Ankylosing Spondylitis: A Case Report

Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease that affects the sacroiliac joints and surrounding joints. It is a seronegative spondyloarthritis that invades connective tissue. Managing cervical spine fractures in patients with AS is particularly challenging due to the severity of the deformity and the instability of the fracture. Cervical spine fracture combined with spinal cord injury is the leading cause of death and is strongly correlated with in-hospital mortality in patients with ankylosing spondylitis. There have been limited reports on the revision of cervical spine fractures after internal fixation in patients with AS. The case report is about a patient who is a 34-year-old man who underwent emergency surgery at a local hospital for a cervical spine fracture resulting from a car accident. A postoperative review revealed that the anterior internal fixation was detached, leading to a revision surgery being performed according to the patient&amp;apos;s actual condition. Unfortunately, the internal fixation became dislodged fol-lowing the initial surgery, exacerbating the patient&amp;apos;s condi-tion and leading to the development of pneumonia. In order to prevent the need for revision surgery, it is crucial to carefully evaluate and determine the most suitable surgical approach for patients with cervical spine fractures and spinal cord injury before proceeding with the initial surgery.

Impact on patient outcomes of spondyloarthritis-inflammatory bowel disease multi-disciplinary meetings.

To assess the impact on patient outcomes of the spondyloarthritis (SpA) and inflammatory bowel disease (IBD) multidisciplinary team (MDT) meetings in a large university hospital. A single-centre retrospective observational case-note review was conducted assessing the outcome of all 226 cases discussed at the SpA-IBD MDT meetings in a large UK university hospital between 2017-2022. A total of 226 patients were discussed. It was deemed that 97% of MDT meetings helped to improve communication between teams, and 100% were educational. A total of 57% of discussions led to an instant change of disease management, while 40% of discussions resulted in a treatment plan that avoided the use of dual advanced therapy. This improved patient safety by reducing immunosuppression. The MDT meetings were highly cost and time efficient; 125 referrals between specialists were avoided, and in 51 cases there was a significant chance of reducing future drug costs. A timely investigation or appointment was arranged following 50% of MDT discussions, helping to clarify the diagnosis and optimise patient care. 9% of meetings enabled drugs to be prescribed to patients that are not yet licenced for the other speciality, thereby improving treatment options available in the management of complex cases. The MDT meetings have been beneficial for patients, the clinical team and the institution. This approach might be considered by other rheumatology and gastroenterology departments.

Effect of dietary interventions on nutritional status in patients with rheumatoid arthritis and spondyloarthritis - A systematic review and meta-analysis

Background & AimPatients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) have an increased risk of developing altered body composition, such as low muscle mass, and an increased risk of developing cardiovascular diseases (CVD).Thus, investigating how to improve body composition and CVD risk factors is a relevant topic to improve management of RA and SpA. The aim of this study was to identify dietary interventions that can improve body composition, as well as reduce CVD risk factors in RA and SpA. MethodsWe searched the databases Medline, Embase and Cochrane. Duplicates were removed using Endnote and records were screened through Rayyan. The primary outcomes were muscle mass (kg) and fat mass (kg). Secondary outcomes were body weight (kg), body mass index (BMI: kg/m2), waist circumference (cm) and lipid profile (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, mmol/L). ResultsA total of 4965 articles were identified, and 17 articles were included in this review, of which 15 were suitable for meta-analysis. We found a reduction in TC and LDL-C, (Mean difference, [95%CI]: -0.36, [-0.63, -0.10], I2 =43%, and -0.20, [-0.35, -0.05], I2=0% respectively). Otherwise, no other significant effect was seen in either primary or secondary outcomes. The evidence was graded as moderate for TC and low for LDL-C. ConclusionDietary interventions might reduce the levels of blood lipids, and consequently, the risk of cardiovascular diseases. However, body composition did not change significantly after a 2-4 month dietary intervention. Both short intervention period and lack of reliable methods to assess body composition are possible explanations for this finding. Further studies of longer duration are needed.

Clinical and Serological Associations of Subclinical Atherosclerosis in Spondyloarthropathy

Background: Patients with spondyloarthropathy (SpA) have a higher risk of subclinical atherosclerosis (SCA). We assessed clinical and serological determinants of SCA in Indian SpA patients. Methods: Patients with SpA (fulfilling ASAS 2010 criteria; n = 104) attending our hospital were recruited; mean carotid intima-media thickness (CIMT) was performed by carotid ultrasonography, along with clinical assessment and traditional risk factor evaluation. Microparticles were extracted from plasma and total, as well as endothelial microparticles (EMP), platelet microparticles, T lymphocyte microparticles and B lymphocyte microparticles, were analysed by flow cytometry. Serum samples were analysed for inflammatory cytokines previously implicated in atherosclerosis, namely interleukin 1β (IL-1β), IL-6, IL-17, IL-27, IL-33 and tumour necrosis factor-alpha. Thirty-eight healthy controls were used for comparison. Subgroup analyses compared parameters between SpA with SCA (i.e., with carotid plaque or more than 75th percentile of CIMT for that age and sex in the Indian population) versus those without SCA. Ethical approval and written, informed consent were obtained. Results: Despite significantly younger age, lower body mass index and higher total cholesterol in controls compared to SpA, those with SpA had higher CIMT. Traditional cardiovascular risk factors (older age, higher waist-hip ratio) and novel markers of inflammation (serum IL-1β, IL-6) were associated with SCA. While total microparticles, EMP, T lymphocyte and B lymphocyte microparticles were increased in SpA than in healthy controls, they were not associated with SCA. Conclusions: Traditional risk factors and serum inflammatory cytokines IL-1β and IL-6 are associated with higher SCA in Indian SpA patients.

Risk of cardiovascular disease decreases over time in psoriatic arthritis but not in spondylarthritis: meta-analysis of longitudinal studies.

SpA and PsA represent two frequent inflammatory rheumatic disorders characterized by an increased burden on quality of life due to the association of several comorbidities, especially cardiovascular disease (CVD). The estimated prevalence of CVD ranges from 12 to 19% and differs between the two diseases, however, the incidence of CVD is not completely known. We aimed to systematically review the literature and perform a meta-analysis of controlled observational studies to assess the incidence rate of CVD over time in SpA and PsA. We performed a systematic literature review (SLR) of longitudinal studies with a study period of at least 5 years, including SpA/PsA patients and general population. The main outcome was the occurrence of CVD, including ischaemic heart disease, stroke and death from CV causes. We then performed a random-effects model for meta-analysis. The SLR included 34 articles, mainly focused on the association between SpA/PsA and CVD. Twenty-four articles were then selected for the meta-analysis. The overall incidence of CVD was increased in PsA [hazard ratio (HR) 1.28 (95% CI 1.15, 1.43)] and in SpA [HR 1.45 (95% CI 1.22, 1.72)] compared with the general population, with consistency across the different types of CVDs. Interestingly the incidence tended to decrease over time in PsA but not in SpA. The SLR and meta-analysis confirmed the increased incidence of CVD in both SpA and PsA patients compared with the general population, although the increase seems to be less prominent in PsA than in SpA. Future studies are needed to confirm our findings.

Delay in Referral to Specialty Care in Patients with Spondyloarthropathy and Psoriatic Arthritis in India: IRA Database Report

Aim: The present study is intended to evaluate the factors influencing the diagnostic and rheumatology care referral delay in patients with spondyloarthropathy (SpA) and psoriatic arthritis (PsA) in India. Materials and methods: The independent prospective, multicentre, observational study collected data from 8 centres across India through the database created by the Indian Rheumatology Association (IRA). Modified Prasad scale was used for socio-economic classification based on the patient’s income. The data of PsA and SpA were analysed separately, and the causes were compared using t-test for continuous variables and chi-square and Fisher’s exact tests for categorical variables. Results: The mean referral delay noted for PsA and SpA subjects were 16.3±34.35 and 17.48±33.59 (IQR 24 and 34) months, respectively. Majority of the PsA patients and about 65% of SpA subjects reported a lack of awareness of the rheumatology specialty as the major reason for the delay. Another major reason was management by other specialists instead of rheumatologists (65% and 74% respectively). Approximately 8% of patients in both disease groups had no faith in modern care due to perceived elevated risk of adverse effects. SpA patients with improved socio-economic status had a higher proportion of subjects seeking specialty care. A direct association was noted between professional skill and early access to specialty care for both PsA and SpA patients. Conclusion: The lack of awareness of rheumatology as a specialty and patients being managed by other specialties are the two major reasons for delayed referral of SpA and PsA. Additionally, a patient’s economic and skill level can influence their ability to access specialty care.

Immune recovery uveitis in Whipple’s disease: an unusual ocular presentation

PurposeTo describe an unusual case of Whipple’s disease (WD) complicated by uveitis, and subsequent paradoxical worsening after effective antibiotic treatment targeting Tropheryma whipplei (TW).MethodsCase report.ResultsA 53-year-old male presented with bilateral knee arthritis, weight loss, chronic low-grade fever, and cognitive disorders. He was under treatment with tumor necrosis factor α inhibitors (TNFi) for seronegative spondyloarthritis. Given this unusual clinical presentation, further investigations were performed and revealed blood, saliva, stool, synovial fluid and cerebrospinal fluid positivity for TW, confirming the diagnosis of systemic WD. Ophthalmologic examination revealed bilateral posterior uveitis and an aqueous humor sample confirmed the presence of intraocular TW. TNFi were stopped, and the patient was subsequently treated with adequate antibiotics (ceftriaxone, followed by doxycycline and hydroxychloroquine), and subconjunctival corticosteroid injections. After a transient improvement of the ocular symptoms, he presented a recurrence of posterior segment inflammation, leading to repeated PCR testing for TW which were negative. Therefore, paradoxical worsening of the inflammation in the context of immune recovery uveitis (IRU) was thought to be the culprit. The patient was treated with systemic corticosteroid therapy, allowing for rapid improvement of the ocular findings.ConclusionsThis case underlines the possibility of IRU complicating WD. Ophthalmologists, rheumatologists, and internists should be aware of this rare complication, particularly in the context of previous immunosuppressive therapy.

Causal association of gut microbiota on spondyloarthritis and its subtypes: a Mendelian randomization analysis.

Despite establishing an association between gut microbiota and spondyloarthritis (SpA) subtypes, the causal relationship between them remains unclear. Gut microbiota data were obtained from the MiBioGen collaboration, and SpA genome-wide association study (GWAS) summary data were obtained from the FinnGen collaboration. We conducted a two-sample Mendelian randomization (MR) analysis using the inverse-variance-weighted method supplemented with four additional MR methods (MR-Egger, weighted median, simple mode, and weighted mode). Pleiotropy and heterogeneity were also assessed. Reverse MR analysis was used to detect reverse causal relationships. We identified 23 causal links between specific gut microbiota taxa and SpA levels. Of these, 22 displayed nominal causal associations, and only one demonstrated a robust causal connection. Actinobacteria id.419 increased the risk of ankylosing spondylitis (AS) (odds ratio (OR) = 1.86 (95% confidence interval (CI): 1.29-2.69); p = 8.63E-04). The family Rikenellaceae id.967 was associated with a reduced risk of both AS (OR = 0.66 (95% CI: 0.47-0.93); p = 1.81E-02) and psoriatic arthritis (OR = 0.70 (95% CI: 0.50-0.97); p = 3.00E-02). Bacillales id.1674 increased the risk of AS (OR = 1.23 (95% CI: 1.00-1.51); p = 4.94E-02) and decreased the risk of enteropathic arthritis (OR = 0.56 (95% CI: 0.35-0.88); p = 1.14E-02). Directional pleiotropy, or heterogeneity, was not observed. No reverse causal associations were observed between the diseases and the gut microbiota. Our MR analysis suggested a genetic-level causal relationship between specific gut microbiota and SpA, providing insights into the underlying mechanisms behind SpA development mediated by gut microbiota.

Diets and Joint Symptoms: A Survey of Moroccan Patients With Chronic Inflammatory Rheumatic Disease.

Introduction The role of diet in the onset or aggravation of chronic diseases, especially chronic inflammatory rheumatic disease (CIRD), such as rheumatoid arthritis (RA) or spondyloarthritis (SpA), is a question frequently asked by patients. Our study aims to investigate whether Moroccan patients report a relationship between certain diets and disease symptoms and to study whether patients adopt specific dietary behaviours in order to relieve their symptoms. Methods This is a cross-sectional survey that included all patients followed for CIRD. The questionnaire has three parts, patients' sociodemographic and clinical data, patients' beliefs and attitudes regarding diet in relation to their joint symptoms, and a list of 24 foods for which patients were asked to indicate whether they aggravate, improve, or leave their joint symptoms unchanged. Results Thirty-four percent of the patients reported that the food had an effect on their symptoms, with 25% of them reporting an aggravation. Honey, garlic, and olive oil were the foods most often reported to improve joint symptoms, while red meat, fish, and legumes were most often reported to worsen symptoms. Age and type of rheumatism were factors associated with reporting that food affects joint symptoms. Twenty-three percent of the patients stated that they had already had discussions about diet with their rheumatologists, while 85.7% showed interest in such discussions. Experience with a food that improves joint symptoms was the only factor associated with discussing the diet with a rheumatologist. Conclusion Nearly one-third of the patients with CIRD reported an effect of diet on their joint symptoms.

Targeted therapies for uveitis in spondyloarthritis: A narrative review

Spondyloarthritis (SpA) encompasses a group of chronic inflammatory disorders of the joints frequently associated with uveitis in almost a quarter of cases. SpA-related uveitis typically affects the eye anterior chamber with sudden onset, causing pain, redness, photophobia, and blurred vision. Ophthalmologists will describe an acute anterior unilateral uveitis. Most patients present with episodic acute anterior non-granulomatous uveitis and retain excellent visual acuity. However, systemic treatments are recommended in the event of frequent relapses (2–3/year) or in rare cases of sight-threatening with ocular complications. The improved understanding of the pathogenesis of SpA has led to the management of this disease by biologics. Here, we review the main data regarding the opportunity to target specific components in inflammatory pathways for the treatment of SpA-related uveitis. These therapies are recommended for long-term control when uveitis relapses occur too frequently despite conventional systemic treatments. Significant benefits have been obtained with the tumor necrosis factor-α inhibitors (TNFis), particularly infliximab and adalimumab. Paradoxically, a high number of uveitis occurrences have been shown on etanercept. Mixed results have been demonstrated with interleukin-17 antagonists (secukinumab) and interleukin-12/interleukin-23 antagonists (ustekinumab) in cases of failure of TNFis. JAK inhibitors seem to be a valuable class of medications for these patients in the future. Although SpA-related uveitis is typically managed with conventional local and/or systemic treatments, these biological/targeted therapies may provide avenues to control both the underlying SpA and uveitis manifestations. Thus, a close collaboration between patients, rheumatologists, internists, and ophthalmologists is needed to optimally manage ocular inflammation in SpA.

Short- and Long-Term Mortality of Hospitalized Patients With Autoimmune Rheumatic Diseases and Serious Infections: A National Cohort Study.

Infectious conditions are a significant cause of mortality in autoimmune rheumatic diseases (ARD). Among patients hospitalized with an infection, we compared in-hospital and long-term (3-year) mortality between those with and without ARD. This retrospective analysis included members of the largest health maintenance organization in Israel, aged > 18 years at the first episode of infection, who required hospitalization during 2003-2019. We compared in-hospital mortality and the results of a 3-year landmark analysis of those who survived the index hospitalization between patients with ARD, according to disease subgroups, and patients without ARD. Additionally, we compared mortality outcomes among patients with ARD, according to subgroup diagnosis, matched in a 1:3 ratio by age, sex, and ethnicity to patients without ARD. Included were 365,247 patients who were admitted for the first time with the diagnosis of a serious infection. Of these, we identified 9755 with rheumatoid arthritis (RA), 1351 with systemic lupus erythematosus, 2120 with spondyloarthritis (SpA), 584 with systemic sclerosis, and 3214 with vasculitis. In a matched multivariate analysis, the risk for in-hospital mortality was lower among patients with RA (odds ratio [OR] 0.89, 95% CI 0.81-0.97) and SpA (OR 0.77, 95% CI 0.63-0.94). In a similar analysis, the risk of 3-year mortality was lower among patients with RA (hazard ratio [HR] 0.82, 95% CI 0.78-0.86) and vasculitis (HR 0.86, 95% CI 0.80-0.93). Among patients hospitalized for an infection, the risk of in-hospital and 3-year mortality was not increased among those with ARD compared to those without ARD.

Unraveling the connection: Uveitis prevalence and risk factors in psoriasis patients - a population-based study.

The association between uveitis and spondyloarthropathy (SpA)-related conditions is well-established. However, evidence describing the link between uveitis and psoriasis, and psoriasis without concomitant SpA-related conditions is scarce and conflicting. This large-scale population-based study sought to describe the prevalence and features of uveitis among psoriasis patients in Israel as well as investigating the risk for uveitis in different subgroups of psoriasis patients compared to the general population. We conducted a retrospective study utilizing the electronic database of the Meuhedet Health Maintenance Organization. The study included all patients diagnosed with psoriasis between 2000 and 2020, each patient was matched with four controls based on age, sex, place of residence, and index date. Logistic regression models were employed to assess the association between psoriasis and uveitis while adjusting for the presence of SpA-related conditions. A total of 61 003 psoriasis patients and 244 012 matched controls were included. The prevalence of uveitis was 1.3% versus 1.1% respectively (OR 1.12; 95% CI 1.10-1.30; p < 0.001). When adjusting to psoriasis severity, concurrent SpA, and psoriasis treatment no significant association was found. The rates of uveitis among psoriasis patients with concurrent SpA-related conditions was 3.2% compared to 1.4% in controls without psoriasis or SpA (OR 2.38; 95% CI 2.00-2.83; p < 0.001), while in psoriasis patients without SpA, the rate of uveitis was 1.0% and was similar to controls. Although crude rates of uveitis were higher in patients with severe psoriasis compared to mild psoriasis (2.1% vs. 1.1%), after adjustment, no significant association compared to controls was found in either group. Our findings suggest that the positive association between psoriasis and uveitis is primarily mediated by the coexistence of other SpA-related conditions. These findings imply the presence of a shared pathogenetic mechanism and set the direction for a phenotypic-targeted screening strategy.

Clinical and Demographic Profiling of Patients with Spondyloarthritis and Its Association with Disease Activity in a Tertiary Hospital in Surabaya, Indonesia

Introduction: The assessment of disease activity is crucial for effectively managing chronic diseases like spondyloarthritis (SpA). Establishing the relationship between disease activity, demographic, and clinical factors is essential for better disease management. This study aimed to delve into the demographic and clinical characteristics of patients at Dr. Soetomo General Academic Hospital, a tertiary hospital in Surabaya, Indonesia, contributing to a comprehensive understanding of SpA occurrences in Surabaya.Methods: Data were obtained from 38 SpA patients’ data classified using ASAS 2009 criteria at Dr. Soetomo General Academic Hospital, excluding individuals with SLE, gout, RA, and septic arthritis. Disease activity was measured using ASDAS-CRP. Association analysis between disease activity, clinical parameters, and demographics was conducted using Mann-Withney U test and Spearman correlation test.Results: Results indicated a male-to-female ratio of 8:30, with patients having a median age of 48 (95% CI: 41-53) and most of the patients had a senior high school education (42.11%). The patients exhibited a mean BMI of 25.19 ± 3.77, a median disease duration of 8.5 (95% CI: 5-10) years, and a median CRP value of 0.2 (95% CI: 0.1-0.5) mg/dL. The majority displayed moderate disease activity, with a median ASDAS-CRP score of 2 (95% CI: 1.5-2.7). Interestingly, no significant correlation was found between disease activity using ASDAS-CRP and the demographic or clinical parameters studied.Conclusion: Disease activities were found not to have correlations with the demography and clinical parameters of patients with SpA from Dr. Soetomo General Academic Hospital in Surabaya, Indonesia. This emphasizes the necessity for further research to comprehend the intricate relationship between disease activity and diverse influencing factors.

AYURVEDIC MANAGEMENT OF JUVENILE ANKYLOSING SPONDYLITIS: A CASE STUDY

A 16year old boy, who wasdiagnosed with Juvenile Ankylosing Spondylitis treated with a combination of Panchakarma procedures and Ayurvedic medicines(Integrative approach). The patient was considered suffering from Aamavata(∼Vata disorder involving bone and joints) and was treated based on fundamentals of treatment as mentioned by ayurvedic texts. Patients condition was assessed every 7 days initially for 1 monthend later monthly.Thescore sets of Assessment of Spondylo Arthritis BASDAI and ASDAS score and symptoms showed substantial improvement after 120 days of treatment.

P493 Do antiTNF or Ustekinumab trough levels correlate with joint extraintestinal manifestations activity in Inflammatory bowel disease patients?

Abstract Background Inflammatory spondyloarthritis(SpA) are the most common extraintestinal manifestations (EIM) associated to inflammatory bowel disease (IBD), with a prevalence of 20-50% for axial SpA(axSpA) and 5-20% for peripheral(pSpA). AntiTNF is the optimal therapy in axSpA intolerant or refractory to NSAIDs, also effective in pSpA. An optimal trough level has not been yet established in this clinical setting. Aim, to evaluate the correlation between antiTNF and UST trough levels and joint EIM activity in IBD patients. Methods Prospective, multicenter,cohort study. IBD patients diagnosed with articular EIM under antiTNF or Ustekinumab(UST) for at least 6 months were included. Blood samples were obtained just before administering the drug(trough levels), and a simultaneous evaluation by a rheumatologist and a gastroenterologist, was performed. Definitions: inactive AxSp=ASDAS-CRP&amp;lt;1.3 and BASDAI&amp;lt;2, inactive pSp=arthritis, enthesitis and dactylitis=0, active AxSp=ASDAS-CRP &amp;gt;2.1 and BASDAI&amp;gt;4, active pSp= artritis, entesitis o dactilitis &amp;gt; 0. Aim, to evaluate the correlation between antiTNF and UST trough levels and joint EIM activity in IBD patients. Results A total of 135 patients were included: mean age 51 ± 15, 59 (43.7%)women), 80% CD. 60(44.4%) patients presented axSpA, 50(37%) pSpA and 25(18.5%) mixed. 12(8.9%) had active IBD. Table 1 summarizes the patients' main demographic and clinical characteristics distributed by SpA activity. Fifty-three(39%) were on infliximab (IFX), 61(45.2%), on adalimumab (ADA) and 22 (16.3%) on UST treatment. NSAIDs treatment(12.7% vs 3.1%, p&amp;lt;0.05), higher fecal calprotectin(FC)(486 ± 709 vs 228.2 ± 297, p&amp;lt;0.05), and the prior use of biologics(33.8% vs 17.6%, p&amp;lt;0.05) were more frequent among active vs inactive SpA patients. No differences between IFX(7.05 ± 4.16 vs 5.79± 4.05, p=ns), ADA(7.98 ± 4.20 vs 9.51 ± 6.15 p=ns) and UST levels(3.39 ± 3.47 vs 3.08 ±2.69, p=ns), were found between active and inactive SpA patients, even when were distributed by type of SpA(axSpA/mixed and pSpA). Body mass index(b:-0,29, p=0.01)FC(b:-0,28, p=0.01), and intensified therapy(b:-0,28, p=0.01) were associated to higher IFX levels in the whole SpA cohort. Patients with axSpA or mixed were articular active more frequently than pSpA patients(82% vs 18%, p &amp;lt;0.05). IBD activity was correlated to articular activity only among pSpA patients(2% active IBD in inactive pSpA vs 20% active IBD in active pSpA patients, p=0.03). Conclusion AntiTNF and UST trough levels are not correlated to joint activity in patients with IBD and SpA. In our study more than 80% of patients with active SpA were inactive regarding IBD. Only pSpA patients presented correlation between IBD and articular activities.

DOP60 Prevalence of undiagnosed inflammatory Bowel Disease in patients with spondyloarthritis: EISER Study

Abstract Background A significant proportion of patients with inflammatory bowel disease (IBD) have concomitant rheumatological manifestations. Patients with spondyloarthritis (SpA) often report gastrointestinal symptoms, some of them being associated to IBD. However, the exact prevalence of this disorder is still controversial, and the optimal approach to its diagnosis remains unknown. Methods Aim: to determine the prevalence of undiagnosed IBD in patients with axial SpA and psoriatic arthritis (PA). EISER is an observational, cross-sectional study carried out in13 Spanish hospitals. Patients ≥18 years-old diagnosed with PA or SpA were selected. Patients receiving biologics or systemic steroids were excluded. Among patients ≥ 50 years, only those without valid colonoscopy in the previous 3 years were included. Rheumatologists performed a baseline visit and collected demographic, clinical data. Fecal calprotectin (FC) was determined by the Quantum Blue rapid test and this was followed by a gastroenterologist consultation. Figure 1 summarizes study protocol. Results A total of 559 patients were included (51% men; mean 52.2 years; mean disease duration of SpA/PA was 12.3 years). The most frequent disease was radiographic SpA (37%), followed by peripheral APs (36%). Tabla 1 shows demographic characteristics of patients. A total of 40% of patients has FC ≥ 80 ug/g. In the multivariate logistic regression analysis factors associated with a greater likelihood of FC ≥ 80 µg/g were disease duration (OR 1.021, 95%CI 1.000 to 1.042, p&amp;lt;0.05) and disease activity by ASDAS-CRP (OR 2.158, 95%CI 0.906 to 5.139, p&amp;lt;0.1), while general health status by EQ-5D-5L was associated with a lower likelihood of FC ≥ 80 µg/g (OR 0.976, 95%CI 0.960 to 0.993, p&amp;lt;0.01). 28 patients were diagnosed of IBD, leading to a prevalence of 5.7%, 22 out of the 248 patients with axial SpA had IBD (8.9%) and 6 out of the 246 patients with PsA (2.4%). 24 were diagnosed with Crohn’s disease (CD), 3 unclassified IBD, and 1 UC. Seven (25.0%) of these IBD patients showed symptoms. The ROC curve for FC and the diagnosis of IBD is presented in Figure 1 (AUC of 0.870 (p&amp;lt;0.001, 95CI% 83.7 to 89.8). The highest sensitivity(S) and specificity (Sp) corresponded to a FC level &amp;gt;147 µg/g (S= 85.7% and a Sp of 75.5%, a PPV of 17.4% (95%CI 14.5 to 20.8) and NPV of 98.9% (95%CI 97.3 to 99.5). Conclusion - 5.7% of SpA patients have undiagnosed IBD. This prevalence was higher among axial SpA than PsA patients. - CD is the most frequent IBD type observed.· - FC is a useful tool to identify patients with SpA and lesions secondary to IBD. - FC has a high NPV to rule out IBD in axial SpA patients. - Disease duration, quality of life and disease activity of SpA are associated with higher levels of FC.

P401 The diagnostic efficacy of the DETAIL questionnaire as a screening tool for spondyloarthritis in Korean patients with Inflammatory Bowel Disease

Abstract Background The DETection of Arthritis in Inflammatory boweL diseases (DETAIL) is a very simple questionnaire consisting of six items. Developed in Italy as a screening tool for spondyloarthritis (SpA) in patients with inflammatory bowel diseases (IBD), it has not been validated in Asian patients with IBD. This study aims to assess whether the DETAIL questionnaire demonstrates appropriate screening properties in Korean patients with IBD. Methods Adult patients with IBD experiencing musculoskeletal symptoms were prospectively enrolled. An IBD specialist assessed them using a Korean-translated version of the DETAIL questionnaire, and referred them to a rheumatologist. The diagnosis of SpA was made based on the Assessment of SpondyloArthritis international Society classification criteria. The performance of the DETAIL questionnaire was evaluated using a Bayesian analysis model, with results graphically represented using Fagan’s nomogram. Results Eighty-seven patients with IBD (58 with ulcerative colitis and 29 with Crohn’s disease) completed the DETAIL questionnaire. Male was 50.1%, and the mean age of the patients was 39.1±12.1 years. Among these patients, 30 (34.5%) were diagnosed with SpA (20 peripheral, 10 axial). In the DETAIL questionnaire, items 1 (exploring peripheral synovitis), 2 (exploring dactylitis), and 3 (exploring Achilles enthesitis), which assess peripheral SpA, demonstrated good performance, especially with the highest positive likelihood ratio (LR+) found in item 2 (LR+ 3.26). Meanwhile, questions about inflammatory low back pain (items 4, 5, and 6), exhibited poorer performance, with LR+ values near or below 1. In subgroup analysis, the DETAIL questionnaire exhibited superior performance in younger IBD patients (&amp;lt; 40 years old) across three items for peripheral SpA, compared to older IBD patients (≥ 40 years old). An affirmative response to at least two questions about peripheral arthritis yielded a posttest probability of SpA of 85% or more. Conclusion The DETAIL questionnaire demonstrates effective screening properties for detecting SpA in young Korean IBD patients.

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

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 &amp;gt; 2.5 mg/dl and faecal calprotectin; FC &amp;gt; 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 &amp;gt; 3.5 mg/dl and CF &amp;gt; 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.

P179 Decrease in Butyric Acid in fecal matter in patients with Inflammatory Bowel Disease is associated with the levels of secretory Immunoglobulin A and fecal calprotectin

Abstract Background Accumulating evidence shows that the development of IBD is always accompanied by dysbiosis of the intestinal microbiota. Short-chain fatty acids (SCFAs) are produced by prebiotic intestinal bacteria, with mportant anti-inflammatory functions, delaying the clinical progression of IBD. The aim of this study is to compare SCFA levels in fecal matter in patients with IBD versus patients with Spondyloarthritis (SpA) and healthy controls. Methods 24 patients were evaluated for the presence of gastrointestinal symptoms, demographic data and inflammatory markers: fecal calprotectin, C-reactive protein (CRP), secretory IgA (SIgA) and erythrocyte sedimentation rate (ESR). The quantification of SCFAs (acetic-AC, propionic-AP, butyric-AB and total SCFAs-ACCC-T) from fecal matter was analyzed by ultra-high pressure liquid chromatography coupled to mass spectrometry (UHPLC-Q/ TOFMS). Results 33.3% of patients with IBD were men, with body mass index &amp;gt;25 in 16.7%; 83.3% presented more than 2 gastrointestinal symptoms at the time of sample collection, 33.3% had high levels of fecal calprotectin, 50% had CRP levels higher than 3mg/L and high ESR in 33.3% and a mean SIgA. of 27.73±5.03 g/mL. Very decreased levels of butyric acid (BA)ug/mL and T-SCFA were observed in IBD (9.45±4.89 and 121.73±65.94, respectively), compared to CS (BA 20.84±8.83 and total SCFA.12±122.09)., SpA SG (AB 13.35±10.44 and total AGCC 150.73±128.52) and SpA without OS (AB 21.13±5.68 and AGCC-T 219.51±229.65). Significant differences were found in fecal BA levels between the study groups (p=0.027). Interestingly, this metabolite in the CS group and the SpA group without OS did not show differences between them, but compared to the IBD group p=0.015 and 0.009 respectively, with a decrease in IBD. And interestingly, no differences were evident between fecal SCFA levels between the IBD group and the SpA group with OS even without a diagnosis of IBD. A principal component analysis was performed for the IBD group where two components were identified that group where COMP.1 was defined by a high correlation between the levels of each of the ACCC (AB CCF= 0.994, AA CCF= 0.935, AP= 0.610 and AGCC-TCCF= 0.910) that had an inverse relationship with COMP.2 which was made up of SIgA (CCF=0.988) and fecal calprotectin (CCF= 0.988). Conclusion SCFAs play a key role in maintaining immune homeostasis both locally and systemically. BA levels were significantly lower in patients with IBD compared to CS and those with SpA. This evidence clearly supports the hypothesis that relates the lack of BA with an exacerbated inflammatory response that could give rise to a dysfunctional intestinal epithelial barrier by regulating the production of mucosal antibodies such as SIgA.