Gastroenterologists should screen for spondyloarthropathy in all patients with inflammatory bowel disease and liaise with their rheumatology colleagues in developing the optimal treatment strategy, Canberra clinicians say.
Rheumatologist Dr Kathie Tymms and gastroenterologist Dr Kavitha Subramaniam from Canberra Hospital 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.”
This did not mean that every patient with SpA should be sent to a gastroenterologist for a ileocolonoscopy, because picking up the 5-15% with IBD was not cost-effective, Dr Kathie Tymms told the limbic.
Instead rheumatologists should look out for SpA patients with symptoms including diarrhoea, rectal bleeding, abdominal pain and weight loss, the presence of perianal problems, anaemia and a family history of IBD, she said.
The spondyloarthritis questionannaire designed by Dr Tymms detects articular(rheumatic), ocular and dermatological features of the spondyloarthritis spectrum also possibly present but not well recognised by gastroenterologists, she added.