The objective of this systematic review and meta-analysis was to give a systematic overview of the prevalence and incidence of SpA in patients with IBD. A total of 71 studies were included, reporting on the prevalence of sacroiliitis, ankylosing spondylitis, arthritis, enthesitis, and dactylitis. Pooled prevalences were calculated. SpA was found to occur in up to 13% of patients with IBD. Ankylosing spondylitis was the least common (3%) followed by sacroiliitis (10%) and peripheral arthritis (13%). Few estimates were available for enthesitis (prevalence range from 1% to 54%) and dactylitis (prevalence range from 0% to 6%).
Another recent systematic review investigated the prevalence of axial SpA, including previously undiagnosed cases, in IBD patients from studies involving cross-sectional imaging. They then also identified the IBD features potentially associated with axial SpA. A total of 20 observational studies were identified. The prevalence of sacroiliitis, the most commonly reported axial SpA feature, ranged from 2.2% to 68.0% with a pooled prevalence of 21.0% (95% confidence interval 17–26%). Associated IBD-axial SpA features include increasing IBD duration, increasing age, male sex, IBD location, inflammatory back pain and peripheral arthritis. No significant difference in the prevalence of sacroiliitis between Crohn’s disease and ulcerative colitis was identified. This work has informed a prospective observational study of magnetic resonance enterography as a screening tool for axial SpA, initiated in March 2019 (ClinicalTrials.gov NCT03817983) https://clinicaltrials.gov/ct2/show/NCT03817983.
Objective: To determine the SpA prevalence and identify its associated factors in Crohn’s disease (CD) patients receiving a systematically rheumatological and imaging assessment, including magnetic resonance imaging (MRI) of the sacroiliac joints and spine.
Results: A total of 103 patients with CD were included in the cohort. The mean CD disease duration was 1.3 ± 2.4 years and 95.1% were naïve to biologics. The most frequent musculoskeletal manifestation was back pain (65.0%), followed by chronic back pain (50.5%), and arthralgia (43.7%). Prevalence of SpA was 19.4% with slightly higher proportion of axial SpA than peripheral SpA, and higher proportion of radiographic axial SpA (7.4%) than non-radiographic axial SpA (2.8%). Changes in MRI compatible with axial SpA were found in 15 (14.7%) patients, of which 9 (81.1%) patients had the clinical diagnosis of axial SpA. HLA-B27 positivity (OR 9.02, CI 95% 2.29–35.55) and higher disease activity of CD as reflected by the HBI (OR 1.14, 95%CI 1.01–1.30) were significant and independently associated with the presence of SpA.
Conclusion: SpA was present in nearly one out of five patients with CD and it was associated with the expression of HLA-B27 and a higher clinical activity of CD. Our findings raise awareness to rheumatologists and gastroenterologists on the high concomitance between both diseases and may help to reduce the delay in SpA diagnosis.
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