Among patients with inflammatory bowel disease (IBD), women, individuals with a history of at least one biological or immunosuppressive therapy, and individuals with Crohn disease are all at an increased risk of developing spondyloarthritis, according to a study published in the Scandinavian Journal of Gastroenterology.

Spondyloarthritis occurs in approximately 20% to 30% of patients with IBD, making it the most common extraintestinal manifestation in IBD. The current study was designed to investigate the risk factors for suspected spondyloarthritis in patients with IBD by giving patients a modified version of the Screening Tool for Rheumatologic Investigation in Psoriatic Patients (STRIPP) questionnaire. Given the similarities between spondyloarthritis associated with psoriasis and spondyloarthritis associated with IBD, an expert panel of 3 rheumatologists and 2 gastroenterologists adapted this Italian, self-administered questionnaire for identifying individuals in need of a rheumatologic consultation to create a rapid questionnaire for rheumatologic investigation in IBD patients (STRII).

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To find the appropriate cut-off value, the questionnaire was first submitted to all consecutive patients at the investigators’ outpatient IBD center (426 patients; 142 with known spondyloarthritis, and 284 with a previous rheumatological visit concluding against spondyloarthritis). Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the STRII questionnaire’s accuracy for identifying spondyloarthritis in IBD. The second phase involved 1147 IBD patients and aimed to investigate risk factors, with P <.05 considered significant.


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In the first phase (N=426), ROC curve analysis showed a ≥3 cut-off correlated with spondyloarthritis diagnosis with an AUC=0.91 (P <.001), a sensitivity of 85.2%, and a specificity of 85.5%. In the second phase (N=1147), 244 patients (21.3%) had a STRII score ≥3, and 99 (8.6%) already had an arthritis diagnosis. Age was not a risk factor for suspected spondyloarthritis, but female sex (29.4% of women had a STRII score ≥3 vs 14.8% of men; P<.0001) and type of IBD were (17.9% of patients with ulcerative colitis had a STRII score ≥3 vs 23.5% of patients with Crohn disease, P =.023). Patients with a history of treatment with at least 1 immunosuppressive (azathioprine, mercaptopurine, methotrexate) for IBD had a higher rate of positivity to the STRII questionnaire (26.9% vs 18.8%; P =.002), as did patients with a history of therapy with at least 1 biological (infliximab, adalimumab, golimumab, vedolizumab, ustekinumab) for IBD (33.6% vs 18.1%; P <.0001).

Study limitations included potential false positive results and a lack of differentiation between axial and peripheral spondyloarthritis. However, study investigators concluded, “most of the patients with suspected SpA (STRII score ≥3) have not yet a diagnosis of SpA. Among all IBD patients, females, Crohn disease, patients with a history of at least 1 immunosuppressive or biological therapy are those at higher risk of a coexistent SpA. These patients are those that should be subjected to a questionnaire like the STRII (active search for SpA): patients with a positive result (i.e., ≥3) should be referred to a rheumatologist.”

Reference

Ribaldone DG, Vernero M, Parisi S, et al. Risk factors of suspected spondyloarthritis among inflammatory bowel disease patients [published online September 24, 2019]. Scand J Gastroenterol. doi: 10.1080/00365521.2019.1668052