Lim CSE, Tremelling M, Hamilton L, Kim M, Macgregor A, Turmezei T, Gaffney K. Prevalence of undiagnosed axial spondyloarthritis in inflammatory bowel disease patients with chronic back pain: secondary care cross-sectional study.
Rheumatology (Oxford) 2022;
62:1511-1518. [PMID:
35993905 DOI:
10.1093/rheumatology/keac473]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/06/2022] [Accepted: 08/06/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE
To elucidate the prevalence of undiagnosed rheumatologist-verified diagnosis of axial spondyloarthritis (RVD-axSpA) in patients attending routine secondary care IBD clinics with chronic back pain.
METHODS
Screening questionnaires were sent to consecutive patients attending IBD clinics in a university teaching hospital. Patients fulling the eligibility criteria (gastroenterologist-verified diagnosis, 18-80 years old, biologic therapy naïve, no previous diagnosis of axSpA); and a moderate diagnostic probability of axSpA (self-reported chronic back pain [CBP] > 3 months, onset < 45 years) were invited for rheumatology assessment. This included medical review, physical examination, patient reported outcome measures, human leucocyte antigen B27, C-reactive protein, pelvic radiograph and axSpA protocol magnetic resonance imaging. A diagnosis of RVD-axSpA was made by a panel of rheumatologists.
RESULTS
Of the 470 patients approached, 91 had self-reported CBP > 3 months, onset < 45 years, of whom 82 were eligible for clinical assessment. The prevalence of undiagnosed RVD-axSpA in patients attending IBD clinics in a secondary care setting, with self-reported CBP, onset < 45 years is estimated at 5% (95% CI 1.3,12.0) with a mean symptom duration of 12 (S.D. 12.4) years.
CONCLUSION
There is a significant hidden disease burden of axSpA among IBD patients. Appropriate identification and referral from gastroenterology is needed to potentially shorten the delay to diagnosis and allow access to appropriate therapy.
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