Ab0949 coexisting Inflammatory Bowel Disease and Ankylosing Spondylitis: Management and Clinical Outcomes

Abstract

BackgroundAnkylosing spondylitis (AS), which occurs in about 10% of inflammatory bowel disease (IBD) patients[1], is more common in Crohn’s disease and does not correlate with bowel activity[2]. The occurrence of IBD in patients with AS is 4-16%[3-5].ObjectivesTo investigate the patterns of treatment modifications following newly diagnosed AS in patients with IBD or a new IBD diagnosis in patients with AS.MethodsThis is a retrospective observational study that included patients with coexisting IBD and AS that were followed simultaneously by the gastroenterology and the rheumatology departments of the Sheba Medical Center. Patients with a follow-up duration of at least 3 months since the second diagnosis were included.ResultsThe cohort consisted of 68 patients, 41 with a first diagnosis of IBD (fIBD-group) and 27 with a first diagnosis of AS (fAS-group). Patients in the fAS-group were younger (median age of 36 years, inter quartile range (IQR) 25-48 vs. 43 years IQR 35-56, p=0.043), had more Crohn’s disease (92.6% vs. 68.3%, p=0.016), had a shorter interval up to the second diagnosis (median of 3 years, IQR 1-6 vs. 6 years, IQR 2-11.5, p=0.03), and had an increased rate of past/current biologic treatment (81% vs. 51%, p=0.019) compared with the fIBD-group. Therapy modifications rates were 78% in the fIBD-group and 96% in the fAS-group. The most common modification for the fIBD-group was initiation of biologic therapy in 18/32 patients (Adalimumab 44%, Infliximab 33%, Golimumab 5.75%, Etanercept 5.75%, Certolizumab pegol 5.75%, Ustekinumab 5.75%). In the fAS-group, switching biologic agent to Adalimumab or Infliximab (42%) and ceasing NSAIDs (27%) were the most common (Figure 1). At 1-year follow-up there were no significant differences in clinical outcomes (treatment failure, surgery/hospitalization, clinical remission) between fIBD and fAS groups. However, patients in both groups with treatment modifications, had a trend for higher rate of IBD clinical remission than patients without (72% vs. 40%, p=0.066). No difference was found in AS clinical outcome.ConclusionTreatment modifications are common among newly coexisting IBD and AS patients, preferably biologic drug modifications. These modifications may contribute to IBD clinical remission.References[1]Harbord M, Annese V, Vavricka SR, et al. The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease.J Crohns Colitis. 2016;10(3):239-254. doi:10.1093/ecco-jcc/jjv213[2]Arvikar SL, Fisher MC. Inflammatory bowel disease associated arthropathy.Curr Rev Musculoskelet Med. 2011;4(3):123-131. doi:10.1007/s12178-011-9085-8[3]Rogler G, Singh A, Kavanaugh A, Rubin DT. Extraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management.Gastroenterology. 2021;161(4):1118-1132. doi:10.1053/j.gastro.2021.07.042[4]de Winter JJ, van Mens LJ, van der Heijde D, Landewé R, Baeten DL. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis.Arthritis Res Ther. 2016;18(1):196. Published 2016 Sep 1. doi:10.1186/s13075-016-1093-z[5]Fragoulis GE, Liava C, Daoussis D, Akriviadis E, Garyfallos A, Dimitroulas T. Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment.World J Gastroenterol. 2019;25(18):2162-2176. doi:10.3748/wjg.v25.i18.2162Figure 1.Cohort stratification by diagnoses and treatment modificationsAS=ankylosing spondylitis; IBD= inflammatory bowel disease; MTX=methotrexate; 5-ASA=5-aminosalicylic acid; 6-MP=mercaptopurine; NSAIDS= non-steroidal anti-inflammatory drugs.Acknowledgements:NIL.Disclosure of InterestsNone Declared.