Chronic Axial Pain Prevalent in Inflammatory Bowel Disease

The following article is a part of conference coverage from the 2019 American College of Rheumatology/The Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, being held in Atlanta, Georgia. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the 2019 ACR/ARP Annual Meeting.

ATLANTA — Chronic axial pain is prevalent in almost a quarter of patients with inflammatory bowel disease (IBD), according to research results presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, held November 8 to 13, 2019, in Atlanta, Georgia.

Researchers used data from the nationally representative 2009-2010 National Health & Nutrition Examination Survey (NHANES) and NHANES 2 (1976-1980) questionnaires to compare the rates of axial pain in patients with and without IBD.

The NHANES questionnaires were used to collect patient data, including history of clinician-diagnosed ulcerative colitis or Crohn disease, gastrointestinal symptoms, medical care, and IBD comorbidities. The surveys also included questions about the timing and anatomic distribution of axial pain of at least 3 months and history of clinically diagnosed arthritis. The NHANES 2009-2010 questionnaire also asked respondents about their pain quality to estimate inflammatory back pain prevalence.

Data from 5105 NHANES 2009-2010 and 13,730 NHANES 2 participants, aged 20 to 69 years, were analyzed. The prevalence of ulcerative colitis was 1.0% in both surveys; in NHANES 2009-2010, the prevalence of IBD was 1.2%. Information from NHANES 2 indicated that ulcerative colitis rates were higher in participants aged 50 to 69 years than in participants aged 20 to 49 years (P <.01), and higher among women compared with men (P <.01).

The analysis showed that compared with patients without IBD, those with IBD were more likely to have pain onset aged >45 years (26.2% vs 40.0%), rest or sleep pain (27.3% vs 42.9%), and pain upon awakening (58.0% vs 90.5%). Rates of axial pain for at least 3 months were nonsignificantly increased among patients with IBD vs those without IBD in NHANES 2009-2010 (27.8% vs 19.2%) and increased with ulcerative colitis in NHANES 2 (22.3% vs 7.8%; P <.01). Both Amor Criteria axial pain (axial pain plus pain at night or morning stiffness) and clinician-diagnosed arthritis were increased among patients with ulcerative colitis in NHANES 2 (21.3% vs 7.4%; P <.01 and 38.5% vs 20.7%; P <.01, respectively).

In NHANES 2009-2010, both inflammatory back pain and spondyloarthritis analyses were limited because of the sample size; however, investigators found that the unadjusted overall estimates for IBD with both inflammatory back pain and spondyloarthritis were 9.7% and 10.0%, respectively, compared with 7.2% and 1.8%, respectively, among healthy controls

“Prevalences of [ulcerative colitis] in these 2 nationally representative population surveys were consistent at 1% of the general population, similar to previous surveys,” the researchers concluded. “Studies with larger sample sizes are required to estimate [inflammatory back pain] and [spondyloarthritis] rates in IBD.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Stens O, Dillon C, Miller FW, Weisman M. The US prevalence of inflammatory bowel disease and associated axial pain: data from the National Health & Nutrition Examination Survey (NHANES). Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. Abstract 1093.