Implementation of screening criteria for inflammatory bowel disease in patients with spondyloarthritis and its association with disease and endoscopic activity

Abstract

There is little literature on the implementation of screening criteria for inflammatory bowel disease (IBD) in patients with spondyloarthritis (SpA). This study aimed to apply IBD screening criteria in a group of patients with SpA without IBD diagnosis and correlate them to endoscopic findings and disease activity. A total of 82 patients with SpA were included. The IBD screening test and ileocolonoscopy with digital chromoendoscopy with magnification and histological analysis were performed. The data were analysed with Chi-square test/Fisher’s exact test and multiple correspondence analysis. The major screening criteria found in 48.7% of the patients were associated with a history of infection (p = 0.037). Rectal bleeding was associated with the diagnosis of ankylosing spondylitis, acute inflammation, enthesitis and tissue architecture alteration in the ileum (p < 0.050). Diarrhoea was associated with a higher disease activity score (p = 0.02). Minor screening criteria were associated with painful inflammatory joint (p = 0.05), high disease activity score (p = 0.001) and high calprotectin levels (p = 0.050). Abdominal pain (36.9%) was associated with axial/peripheral compromise (p = 0.017), inflammatory back pain (p = 0.01), enthesitis (p = 0.021), higher disease activity score (p = 0.023) and acute ileum inflammation (p = 0.046). Diarrhoea of 4 weeks and abdominal pain were the most prevalent major and minor screening criteria, respectively, being related to early manifestations of inflammatory bowel compromise and higher disease activity score. This screening test grants a chance of opportune referral of SpA patients from rheumatology to gastroenterology.

Navigating Comorbidities in Chronic Inflammatory Rheumatic Diseases: Insight and Strategies

“…87 The screening process for GI comorbidities is similar in the general population and individuals with CIRDs, relying on symptom-based evaluation. 7,86,88 However, certain CIRDs require a more thorough screening due to their heightened risk of specific GI issues.…”

“…84 Techniques like digital chromoendoscopy and magnification colonoscopy are utilised to facilitate effective IBD screening, alongside a range of laboratory tests to assess markers like C-reactive protein, sedimentation rate, transferrin, ferritin, and vitamin B12 levels. 85,88 Employing digital chromoendoscopy or magnification endoscopy aids in identifying and monitoring early lesions. 89 IBD screening involves specific criteria, encompassing both major symptoms such as rectal bleeding, diarrhoea exceeding 4 weeks, and perianal disease, as well as minor indicators like prolonged abdominal pain, iron deficiency anaemia, and extra-intestinal manifestations such as aphthous stomatitis, fever, unexplained weight loss, family history of IBD, and vitamin B12 deficiency.…”

“…89 IBD screening involves specific criteria, encompassing both major symptoms such as rectal bleeding, diarrhoea exceeding 4 weeks, and perianal disease, as well as minor indicators like prolonged abdominal pain, iron deficiency anaemia, and extra-intestinal manifestations such as aphthous stomatitis, fever, unexplained weight loss, family history of IBD, and vitamin B12 deficiency. 88 A study conducted by Andréasson et al investigated faecal calprotectin (FC) levels, commonly used in primary healthcare, to determine if patients should be referred for endoscopy in individuals with Sjögren's syndrome. 90 They found that an FC level exceeding 150 μg/g could indicate underlying GI conditions such as malignancy or IBD.…”

The Role of Sclerostin in Rheumatic Diseases: A Review

“…Chronic inflammation in RA is associated with endothelial dysfunction and the formation of arteriosclerotic lesions. Advanced arteriosclerosis is marked by particularly severe arterial calcification [10][11][12], mainly involving the intimal layer [13]; calcification of the medial layer (Mönckeberg's calcification) may develop independently of changes observed in arteriosclerosis [14]. While intimal calcifications occupy focal areas and are mainly found in arteriosclerotic plaque, calcifications in the medial layer display a linear pattern [15].…”

“…Spondyloarthropathies (SpAs) are inflammatory diseases involving spinal joints, peripheral joints and tendons. These include the following: ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis and non-specific inflammatory bowel diseaseassociated arthritis [12][13][14][15]. Sclerostin, a glycoprotein produced and released primarily by mature osteocytes, is an inhibitor of Wnt/β-catenin pathway-dependent osteoblast proliferation and differentiation from mesenchymal stem cells [16].…”