Gastroenterologists should screen for spondyloarthropathy (SpA) in all patients with inflammatory bowel disease and liaise with their rheumatology colleagues in developing the optimal treatment strategy, Canberra clinicians have claimed.
Gastroenterologist Dr Kavitha Subramaniam, from Canberra Hospital, and colleagues found that 29% of 140 patients treated with TNF inhibitors for Crohn’s disease or ulcerative colitis had a past or current history of inflammatory back pain.
Writing in the Internal Medicine Journal, they said 30% fulfilled the imaging criteria for axial SpA and 14% fulfilled the clinical criteria.
Arthritis was reported by 34%, enthesitis 17%, dactylitis 4%, uveitis 6%, psoriasis 6% and a family history of SpA in 39% of all patients.
Dr Subramaniam told the limbic that the study confirmed the high rate of musculoskeletal manifestations in IBD patients.
“Although TNF inhibitors are used for both conditions, the prevalence before the treatment is started in these patients with more severe disease may be much higher than recognised by the specialist dealing with only one aspect of the SpA disease spectrum,” she says.
“When IBD and SpA are found to coexist after screening, the therapeutic strategy should be modulated with consideration of risk-benefit across all potential inflammatory presentations – including arthritis, psoriasis, uveitis and colitis.
“Treatment of SpA should be multidisciplinary and individualised with close cooperation between the specialties, taking into account all the current manifestations.”
She says it’s essential to understand the whole spectrum of SpA and the potential for early diagnosis of non-radiographic axial SpA to facilitate better management.
Signals of possible early SpA include the onset of chronic low back pain before the age of 45, HLA-B27 positivity, and other features such as sausage fingers or toes resulting from dactylitis, psoriatic rash, painful red eyes suggesting uveitis, and enthesitis manifest as pain on tendons’ attachment to bone.
Management of active intestinal disease will remain the focus of gastroenterologists for patients with IBD, but effective treatments for SpA are also available.
They include an active physical exercise program, NSAIDs/Cox2 inhibitors, intra-articular steroid joint injections, disease modifying anti-inflammatory drugs (sulfsalazine, methotrexate, leflunomide) for peripheral arthritis, and other TNF inhibitor therapies for peripheral and axial SpA.