Prevalence of Undiagnosed Inflammatory Bowel Disease in Spondyloarthritis Patients

<b>Background/Objectives</b>: The prevalence of inflammatory bowel disease (IBD) in spondyloarthritis (SpA) patients is unknown. Our objective was to assess the prevalence of undiagnosed IBD in SpA patients, including those with axial spondylarthritis (axSpA) or psoriatic arthritis (PsA). Additionally, we examined fecal calprotectin (FC) levels in relation to the accuracy of IBD diagnosis. <b>Methods</b>: EISER was a cross-sectional, multicenter, observational, rheumatologist-gastroenterologist collaborative study. Patients with SpA naïve to biologics were recruited. Demographic and clinical characteristics, disease activity, and treatment information were collected. Patients with FC ≥ 80 µg/g or IBD-related symptoms underwent a colonoscopy or video capsule endoscopy. Receiver operating characteristic analysis assessed the predictive value of FC for IBD diagnosis. <b>Results</b>: Of the 570 patients recruited, 494 were evaluable for the main outcome, 248 (50.2%) had axSpA, and 246 (49.8%) had PsA. Overall, 28/494 patients were diagnosed with IBD (5.7%, 95%CI 3.6-7.7). Sorted by clinical entity, 22 (8.9%, 95%CI 5.3-12.4) axSpA and 6 (2.4%, 95%CI 0.5-4.4) PsA patients had a diagnosis of IBD: 24 (86%, 95%CI 79.4-92.6) had ileal/ileocolonic Crohn's disease (CD), 3 (11%, 95%CI 5.1-16.9) unclassified IBD, and 1 (3.5%, 95%CI 0.0-6.9) ulcerative colitis. The ROC curve for FC and IBD diagnosis (AUC: 0.870, <i>p</i> < 0.001, 95%CI 83.7-89.8) showed that an FC ≥ 147 µg/g had a positive predictive value of 17.4% (95%CI 14.5-20.8) <b>Conclusions</b>: In SpA, the prevalence of undiagnosed IBD was 5.7%, higher in axSpA (8.9%) than in PsA (2.4%) patients, with CD being the most common. SpA patients with FC levels < 147 µg/g had a very low probability of IBD.

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Publication Details

Journal
Journal of Clinical Medicine
Published
2025-06-27
DOI
https://doi.org/10.3390/jcm14134569
Primary Topic
Spondyloarthritis Studies and Treatments
Type
article
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article

Prevalence of Undiagnosed Inflammatory Bowel Disease in Spondyloarthritis Patients

Lourdes Ladehesa-Pineda, María Luz García-Vivar, Yago González‐Lama, M D C Muñoz-Villafranca et al.
Journal of Clinical Medicine
Spondyloarthritis Studies and Treatments
article

Prevalence of Undiagnosed Inflammatory Bowel Disease in Spondyloarthritis Patients

Lourdes Ladehesa-Pineda, María Luz García-Vivar, Yago González‐Lama, M D C Muñoz-Villafranca, E Iglesias-Flores, Vanesa Hernández-Hernández, Federico Díaz‐González, Xavier Calvet, Eva Pérez‐Pampín, Ana Gutiérrez, Manuel Barreiro‐de Acosta, Marta Carrillo‐Palau, Zulema Plaza, Jordi Gratacós, E. Trujillo, C. Merino Argumánez, Iago Rodríguez–Lago, Jesús Sanz, Ignacio Marín-Jiménez, Marta Arévalo-Salaet
article en

Abstract

<b>Background/Objectives</b>: The prevalence of inflammatory bowel disease (IBD) in spondyloarthritis (SpA) patients is unknown. Our objective was to assess the prevalence of undiagnosed IBD in SpA patients, including those with axial spondylarthritis (axSpA) or psoriatic arthritis (PsA). Additionally, we examined fecal calprotectin (FC) levels in relation to the accuracy of IBD diagnosis. <b>Methods</b>: EISER was a cross-sectional, multicenter, observational, rheumatologist-gastroenterologist collaborative study. Patients with SpA naïve to biologics were recruited. Demographic and clinical characteristics, disease activity, and treatment information were collected. Patients with FC ≥ 80 µg/g or IBD-related symptoms underwent a colonoscopy or video capsule endoscopy. Receiver operating characteristic analysis assessed the predictive value of FC for IBD diagnosis. <b>Results</b>: Of the 570 patients recruited, 494 were evaluable for the main outcome, 248 (50.2%) had axSpA, and 246 (49.8%) had PsA. Overall, 28/494 patients were diagnosed with IBD (5.7%, 95%CI 3.6-7.7). Sorted by clinical entity, 22 (8.9%, 95%CI 5.3-12.4) axSpA and 6 (2.4%, 95%CI 0.5-4.4) PsA patients had a diagnosis of IBD: 24 (86%, 95%CI 79.4-92.6) had ileal/ileocolonic Crohn's disease (CD), 3 (11%, 95%CI 5.1-16.9) unclassified IBD, and 1 (3.5%, 95%CI 0.0-6.9) ulcerative colitis. The ROC curve for FC and IBD diagnosis (AUC: 0.870, <i>p</i> < 0.001, 95%CI 83.7-89.8) showed that an FC ≥ 147 µg/g had a positive predictive value of 17.4% (95%CI 14.5-20.8) <b>Conclusions</b>: In SpA, the prevalence of undiagnosed IBD was 5.7%, higher in axSpA (8.9%) than in PsA (2.4%) patients, with CD being the most common. SpA patients with FC levels < 147 µg/g had a very low probability of IBD.

Journal of Clinical MedicineVol. 14(13)
Universitat Autònoma de Barcelona (ES), Universidad de La Laguna (ES), Hospital Universitario de Canarias (ES), Instituto de Salud Carlos III (ES), Hospital General Universitario Gregorio Marañón (ES), Hospital de Basurto (ES), Complejo Hospitalario Universitario de Santiago (ES), Sociedad Española de Reumatología (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Corporació Sanitària Parc Taulí (ES), Hospital de Galdakao (ES), Hospital Universitario Reina Sofía (ES), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES), Institute of Research and Innovation Parc Tauli (ES), Hospital General Universitario de Alicante Doctor Balmis (ES), Instituto de Investigación Sanitaria de Santiago (ES)
Amgen, Eli Lilly and Company, Pfizer, Danone, Celltrion, Eusko Jaurlaritza, Shire, Vifor Pharma, Otsuka Pharmaceutical, Tillotts Pharma, Societat Catalana de Digestologia, Dr. Falk Pharma
Good health and well-being
Openalex Percentile: Top 75%
Spondyloarthritis Studies and Treatments
DOIOpen Access PDFOpenAlex
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