The following article is a part of conference coverage from the American College of Rheumatology Convergence 2020, being held virtually from November 5 to 9, 2020. 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 ACR Convergence 2020.

There may be a significant hidden prevalence of axial spondyloarthritis (axSpA) in patients with inflammatory bowel disease (IBD), according to study results presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.

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While previous studies have supported the close association between IBD and axSpA, the burden of hidden axSpA among patients with IBD is still unknown. The objective of the current study was to determine the hidden prevalence of axSpA in patients with IBD in secondary care.

Study authors sent screening questionnaires to adults (aged 18-80 years) with IBD who were treated in a large hospital between September 2017 and February 2019. All participants had self-reported chronic back pain, onset of which was before 45 years of age. Participants were invited for rheumatologic assessments that included a medical interview, physical examination, patient reported outcomes, laboratory tests, and imaging studies.

Of 470 patients, 191 responded and the data of 173 (mean age, 52 years; 37% men) with valid completed questionnaires were available for assessment. More than a half the number of participants (n=91; 53%) had chronic back pain, which started before 45 years of age. The prevalence of rheumatologist-verified diagnosis of axSpA in patients with IBD with chronic back pain onset before 45 years of age was 5% (95% CI, 1.3%-12.0%), and the mean delay to diagnosis was 12 (SD, 12.4) years. Inflammatory back pain was diagnosed in 20% of patients, and 38%, 35%, and 29% of patients fulfilled the Calin, Berlin, and Assessment of SpondyloArthritis International Society (ASAS) classification criteria, respectively.

Common manifestations included acute anterior uveitis (5%), skin psoriasis (7%), and other peripheral musculoskeletal axSpA manifestations (16%). Family history of axSpA- related conditions was reported in approximately one-third of patients (n=29), including IBD (62%), skin psoriasis (52%), and axSpA (4%).

Overall, the study authors suggested a significant hidden disease burden of axSpA in patients with IBD with self-reported chronic back pain that started before 45 years of age. 

“Greater awareness and education are still needed. We need to get it right first time by appropriate identification and referral from gastroenterology to rheumatology, in order to potentially shorten the delay to diagnosis and allow access to effective therapy,” the study authors concluded.

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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Lim CSE, Tremelling M, Hamilton L, et al. Prevalence of undiagnosed axial spondyloarthritis among patients with inflammatory bowel disease: a secondary care cross-sectional study. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 1309.