Ankylosing Spondylitis and Axial Spondyloarthritis in Patients With Long-term Inflammatory Bowel Disease: Results From 20 Years of Follow-up in the IBSEN Study

Ossum, Alvilde Maria; Palm, Øyvind; Lunder, Aida Kapic; Cvancarova, Milada; Banitalebi, Hasan; Negård, Anne; Høie, Ole; Henriksen, Magne; Moum, Bjørn; Høivik, Marte Lie

doi:10.1093/ecco-jcc/jjx126

Cited by 57 publications

(48 citation statements)

References 144 publications

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“…The novel nding of our study was that fCAL concentrations were signi cantly higher in ErA patients with any of the MRI sign characteristic for the SlJ in ammation according to consensus de nitions of components of the JAMRIS-SIJ (30). This nding adds to the growing number of evidences for a clinical association of gut in ammation and axial spondyloarthritis in adult patients (34)(35)(36)(37). Rheumatology based studies are reporting that 5-10% of patients with ankylosing spondylitis, a subtype of SpA with the most prominent axial in ammation, have IBD, while almost 50% of patients have subclinical gut in ammation (34).…”

Section: Discussionsupporting

confidence: 53%

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The Increased Levels of Faecal Calprotectin in Children With Active Enthesitis Related Arthritis and Mri Signs of Sacroiliitis: the Results of A Single Centre Cross-Sectional Study in Juvenile Idiopathic Arthritis Patients

Lamot

Miler

Vukojevic

et al. 2020

Preprint

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Background: Enthesitis related arthritis (ErA) is a specific subtype of juvenile idiopathic arthritis (JIA) which is often regarded as an undifferentiated form of juvenile spondyloarthritis (jSpA). Beside the arthritis of the peripheral joints, the crucial features of jSpA include enthesitis and/or arthritis of axial joints. Moreover, in adult onset spondyloarthritis gut is increasingly recognized as origin and/or target of inflammation, while the incidence of gut involvement in ErA patients is still largely unknown. The aim of this study was to assess the fCAL concentration, a surrogate marker of gut inflammation, in patients with various subtypes of JIA and non-inflammatory musculoskeletal conditions and to assess the correlation with various demographic, clinical, laboratory, imaging and treatment characteristics.Methods: This was a cross-sectional study involving 71 patients with various forms of JIA and other noninflammatory musculoskeletal diseases (NI-MSD). Along with detailed clinical and laboratory examination, fCAL and magnetic resonance imaging (MRI) of sacroiliac joints, thoracic and lumbar spine was routinely performed in all ErA patients, as well as in other patients who complained of abdominal and/or back pain, respectively. In all JIA patients, disease activity was measured using the juvenile arthritis (JADAS) or spondyloarthritis (jSpADA) disease activity score. Results: The median concentration of fCAL was highest in ErA subgroup (33.2 mg/kg, p=0.043), with a significant difference between patients with inactive and active disease (20.0 mg/kg vs 57.4 mg/kg, p=0.01), as well as between those with or without MRI signs of SIJ inflammation (22.6 mg/kg vs 54.3 mg/kg, p=0.048). In all patients, the fCAL concentration did not significantly differ among those receiving and not receiving NSAIDs (23 mg/kg vs 20 mg/kg, p=0.18), although weak correlation was found with the duration of the use (r=0.25, p=0.03).Conclusion: The (subclinical) gut inflammation might not be present only in adults with SpA, but also in children with undifferentiated forms of the jSpA, especially with active disease and/or MRI signs of SI inflammation.

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Section: Discussionsupporting

confidence: 53%

“…Similarly, gastroenterologybased studies provide a complementary view. A 20 years long prospective study of 599 patients with IBD have shown that 45% of patients is reporting a chronic back pain (35). In these studies, chronicity of IBD was signi cantly associated with comorbid axial SpA compared with patients without back complaints.…”

Section: Discussionmentioning

confidence: 99%

The Increased Levels of Faecal Calprotectin in Children With Active Enthesitis Related Arthritis and Mri Signs of Sacroiliitis: the Results of A Single Centre Cross-Sectional Study in Juvenile Idiopathic Arthritis Patients

Lamot

Miler

Vukojevic

et al. 2020

Preprint

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“…We showed that half (52.9%) of the IBD patients suffered from LBP with an inflammatory component in 19.6% of cases. In studies where Calin and ESSG (European Spondyloarthropathy Study Group) criteria were used to evaluate patients with IBD, the prevalence of inflammatory LBP in IBD patients ranged from 5 to 30% [3, 4, 7, 16-21].…”

Section: Discussionmentioning

confidence: 99%

Low Back Pain and Sacroiliitis on Cross-Sectional Abdominal Imaging for Axial Spondyloarthritis Diagnosis in Inflammatory Bowel Diseases

Fauny¹,

Cohen²,

Morizot³

et al. 2020

Inflamm Intest Dis

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Background: Joint damage is the most frequent extraintestinal manifestation in inflammatory bowel disease (IBD). Aims: The aim of the study was to assess the value of low back pain (LBP) associated with sacroiliitis on abdominal imaging for the diagnosis of spondyloarthritis (SpA) in IBD. Methods: We used a questionnaire assessing rheumatological symptoms for all patients with abdominal computed tomography (CT) and magnetic resonance enterography (MRE). Sacroiliitis was assessed on available CT and MRE. Patients were classified as axial SpA according to the Assessment of SpondyloArthritis International Society criteria. Results: Fifty-one patients completed the questionnaire and performed both exams. LBP was present in 27 patients (52.9%), and 10 (19.6%) had an inflammatory component. Sacroiliitis was reported in 12 patients (23.5%), and 6 of them suffered from LBP. Among the 20 patients referred to the rheumatologist, 11 patients suffered from LBP. One patient was HLA-B27 positive and presented sacroiliitis. For the last 10 patients, none of them had a sacroiliitis, and 2 patients were negative for HLA-B27. Conclusion: An axial SpA has been diagnosed in 11.8% of IBD patients undergoing crosssectional imaging, whereas one-fifth had inflammatory LBP, and sacroiliitis was observed in one-quarter of them. To optimize the diagnosis of axial SpA, HLA-B27 testing might be required for patients with both IBD and LBP, but this will require further investigation before its implementation in routine practice.

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“…HLA-B27 is notably genetic associated with Ankylosing spondylitis, a class of immune-mediated arthritis termed 'spondyloarthritis' (SpA) [98]. The prevalence of HLA-B27 in SpA/IBD populations is still questionable [33], but HLA-B27 was found to be positively associated with inflammatory back disorders [99], and asymmetrical, nonerosive peripheral arthritis (namely oligoarticular) in IBD patients [100][101][102][103]. HLA-B27 transgenic (B27-Tg) rats develop a multisystemic inflammatory disease that display two important inflammatory features, IBD and peripheral arthritis resembling human spondyloarthritis [57].…”

Section: Models Based On Genetic Modificationmentioning

confidence: 99%

Mechanisms Underlying Bone Loss Associated with Gut Inflammation

Arra

Abu‐Amer

2019

IJMS

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Patients with gastrointestinal diseases frequently suffer from skeletal abnormality, characterized by reduced bone mineral density, increased fracture risk, and/or joint inflammation. This pathological process is characterized by altered immune cell activity and elevated inflammatory cytokines in the bone marrow microenvironment due to disrupted gut immune response. Gastrointestinal disease is recognized as an immune malfunction driven by multiple factors, including cytokines and signaling molecules. However, the mechanism by which intestinal inflammation magnified by gut-residing actors stimulates bone loss remains to be elucidated. In this article, we discuss the main risk factors potentially contributing to intestinal disease-associated bone loss, and summarize current animal models, illustrating gut-bone axis to bridge the gap between intestinal inflammation and skeletal disease.

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Ankylosing Spondylitis and Axial Spondyloarthritis in Patients With Long-term Inflammatory Bowel Disease: Results From 20 Years of Follow-up in the IBSEN Study

Cited by 57 publications

References 144 publications

The Increased Levels of Faecal Calprotectin in Children With Active Enthesitis Related Arthritis and Mri Signs of Sacroiliitis: the Results of A Single Centre Cross-Sectional Study in Juvenile Idiopathic Arthritis Patients

The Increased Levels of Faecal Calprotectin in Children With Active Enthesitis Related Arthritis and Mri Signs of Sacroiliitis: the Results of A Single Centre Cross-Sectional Study in Juvenile Idiopathic Arthritis Patients

Low Back Pain and Sacroiliitis on Cross-Sectional Abdominal Imaging for Axial Spondyloarthritis Diagnosis in Inflammatory Bowel Diseases

Mechanisms Underlying Bone Loss Associated with Gut Inflammation

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