Prevalence of Axial Pain and Arthritis Assessed in Inflammatory Bowel Disease

Closeup shot of a woman suffering with stomach cramps at home
Using NHANES data, researchers estimated the prevalence of chronic axial pain, inflammatory back pain, axial spondyloarthritis, and peripheral arthritis in inflammatory bowel disease.

Axial pain and arthritis may be underdiagnosed among patients with inflammatory bowel disease (IBD), according to study results published in Mayo Clinic Proceedings: Innovations, Quality, and Outcomes.

Patients with IBD are shown to have high morbidity rates. Although musculoskeletal conditions like axial spondyloarthritis (axSpA) and peripheral spondyloarthritis (pSpA) can increase morbidity, their prevalence among individuals with IBD has not been clear.

Given the relatively high rates of chronic axial pain in IBD, researchers examined the prevalence of IBD-related back pain, inflammatory back pain (IBP), axSpA, and pSpA among patients with IBD.

Researchers analyzed the 1976 to 1980 and the 2009 to 2010 datasets from the US National Health and Nutrition Examination Survey (NHANES), which estimates the prevalence of diagnosed axial pain, peripheral arthritis, and IBD in the US.

The 1976 to 1980 survey included data from 5105 individuals (62 with IBD) aged between 20 and 69 years. The 2009 to 2010 survey included 13,566 participants (164 with ulcerative colitis [UC]) in the 25- to 74-year age range. Both surveys included data for chronic axial pain, defined as having pain most days for at least 3 months. The 1976 to 1980 cycle included data for peripheral arthritis occurring for 6 weeks or longer but lacked variables to measure IBP and axSpA. Variables for arthritis included interview-based diagnosis, interviews to measure peripheral joint pain and swelling, medical exams to assess joint pain and swelling, and axSpA using the European Spondyloarthropathy Study Group or Amor criteria. The researchers used sample weighting to account for unequal distributions of samples, noncoverage, and nonresponse.

The researchers observed that axial pain in the 1976 to 1980 cycle was more prevalent among individuals with UC than the general population (19.5% vs 7.2%, respectively; P <.01). Patients with UC vs the general US population also had a greater chance of Amor criteria-based axial pain (13.0% vs 4.3%, respectively; P <.01).

From the 2009 to 2010 data, a difference in axial pain was noted between individuals with IBD and the general population (27.7% vs 19.1%, respectively); however, this increase was not statistically significant. Arthritis diagnoses were more prevalent among those with IBD than the general US population (28% vs 19%, respectively; =.11). Patients with axial pain first experienced symptoms at 45 years or younger, however, those with IBD were more likely to see onset of axial pain at 45 years or older (46% vs 26%, respectively) and more likely to experience pain during sleep and wake up from the pain (43% vs 91%, respectively) than younger diagnosed individuals (27% vs 58%, respectively).

One study limitation was that only a few patients with IBD satisfied the axSpA or IBP criteria for inclusion, which indicates that current standards may not be adequate to determine the prevalence of arthritis or pain.

According to the researchers, “…many older patients with IBD-related axSpA may be underdiagnosed and better served by developing diagnostic criteria without an age cutoff.”

They also suggested that future studies should confirm these findings and lead to a greater understanding of the burden of IBD on patients and the US health care system.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Weisman MH, Stens O, Kim HS, Hou JK, Miller FW, Dillon CF. Axial pain and arthritis in diagnosed inflammatory bowel disease: US National Health and Nutrition Examination Survey data. Mayo Clin Proc Inn Quasl Out. Published online September 15, 2022. doi:10.1016/j.mayocpiqo.2022.04.007