Patients with spondyloarthritis (SpA) and associated inflammatory bowel disease (IBD) may show early signs of oral inflammation, according to research presented at the Advances in Inflammatory Bowel Diseases (AIBD) 2021 Annual Meeting, held from December 9 to 11, 2021, in Orlando, Florida and virtually.

Extra-articular gastrointestinal (GI) manifestations, such as IBD, are observed in patients with SpA. Besides affecting the intestines, IBD also affects the oral cavity during early disease course. Studies comparing the oral manifestations and associated IBD among patients with SpA are limited.

Researchers of the current study sought to identify oral clinical manifestations due to oral mucosa changes associated with IBD among patients with SpA without a diagnosis of IBD. They then compared the results with endoscopic and histological findings.

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The study included 80 patients with SpA (44% women; mean age, 42.8 years; body mass index [BMI], 23.9-28.4 kg/m2) and 52 healthy individuals (46% women; mean age, 41 years; BMI, 22.9-27.6 kg/m2) as controls. They were assessed for intra- and extra-oral findings following World Health Organization guidelines and clinical parameters for rheumatological, GI, and laboratory activity. Ileocolonoscopic and histologic analyses were performed to confirm IBD.

Results of the study reported an increased presence of GI manifestations and symptoms in patients with SpA compared with the healthy controls (69% vs 7.7%, respectively; P =.001). Colonoscopy was performed in 41 patients presenting with GI symptoms. Results showed changes in the mucosa of the rectum and the sigmoid colon (17%). Ileum mucosal changes were observed in 41.5% of the patients.

Oral lesions were observed in 63% of patients with SpA compared with healthy controls (P =.050). IBD-associated oral lesions were predominantly gingivitis (55%), followed by aphthous stomatitis (3.8%), angular cheilitis (2.6%), and perioral erythema with scaling (1.3%). All the patients presenting with colonic mucosal changes had IBD-associated oral lesions (P =.039) and were significantly associated with the presence of gingivitis/aphthous stomatitis (P =.029).

Researchers concluded, “Patients with SpA without a diagnosis of IBD have more oral signs and symptoms compared to healthy controls. Gingivitis is important given its association with early endoscopic and histological findings. Manifestations in the oral cavity can precede intestinal manifestations, therefore the clinical assessment by the oral pathologist in conjunction with gastroenterology and rheumatology allows a timely referral to gastroenterology and an endoscopic and histological evaluation, impacting the quality of life of patients.”


Viviana PI, Katherin C, Julio A, et al. Oral inflammatory changes associated with inflammatory bowel disease in spondyloarthritis associated with early endoscopic findings. Presented at: AIBD 2021 Annual Meeting; December 9-11, 2021; Orlando, FL and virtual. Abstract P050.

This article originally appeared on Gastroenterology Advisor