S1997 Presence of Spondyloarthritis Symptoms in IBD Is Associated With Higher Medication Use and Worse-Long Term Outcomes

Introduction: Musculoskeletal symptoms are the most common extra-intestinal manifestation of inflammatory bowel disease (IBD), with spondyloarthritis (SpA) reported in up to 50% of patients with IBD. In a recent study, we reported that 35% of IBD patients without known rheumatologic disease screened positive for SpA symptoms. In this follow-up study, we assessed the impact of a positive SpA screen on clinical outcomes at 1-year. Methods: We previously administered 2 validated screening questionnaires for the detection of SpA in IBD (DETAIL = DETection of Arthritis in Inflammatory boweL diseases, IBIS-Q = IBD Identification of Spondyloarthritis Questionnaire) to IBD patients without a prior diagnosis of SpA. IBD providers were blinded to the questionnaire results. In this follow-up study, long-term outcomes up to 1 year after SpA screening were assessed by chart review. For all patients with available follow-up, we assessed subsequent rheumatologic evaluation, new medication initiation, and IBD or SpA-related clinical outcomes. Results: This observational cohort included 317 patients (120 ulcerative colitis, 189 Crohn’s disease, 8 IBD-unclassified) with a median age of 38 years (IQR 29–51) and a 29% screen positive rate. When assessing clinical outcomes at 1-year, positive SpA screens were associated with numerically higher rates of a composite outcome of IBD- or SpA-related ED visit, hospitalization or IBD-related surgery (15% vs 8%; P = 0.06). Screen-positive patients also had a significantly higher rate of NSAID use (8% vs 2%; P = 0.02) and numerically higher rates of new biologic, systemic corticosteroid, and opioid use. A positive SpA screen was associated with a higher use of any of these medications as a composite outcome (37% vs 23%; P = 0.02). On multivariate analysis, a positive SpA screen (OR 1.8 [95% CI 1.01-3.1]), and higher number of prior advanced IBD therapy exposures (OR 1.5 [95% CI 1.2-1.9]) were significantly associated with medication use. Among patients with any positive SpA screen, a higher proportion were ultimately seen by a rheumatologist (9% vs 2%; P < 0.01). Conclusion: In patients with IBD, symptoms suggestive of SpA are associated with an increased risk of worse long-term IBD outcomes and a higher use of a combination of biologics, corticosteroids, opioids, and NSAIDs. Rheumatology referral rates remain low however, so strategies are needed to promote early identification and optimize treatment of SpA in patients with IBD.