Chronic Axial Pain Prevalent in Inflammatory Bowel Disease

woman being consulted for back pain
woman being consulted for back pain
This study evaluated previously unreported data from the NHANES 2009-2010 and NHANES 2 (1976-1980) questionnaires that were used to compare axial pain rates among patients with and without inflammatory bowel disease.

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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.

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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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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.