Detection of Crohn Disease in Patients with Spondyloarthropathy: The SpACE Capsule Study

Abstract

Objective.Inflammatory bowel disease (IBD) is generally reported to be associated with spondylarthropathies (SpA) in 5%–15% of cases. Systematic colonoscopic assessment by protocol demonstrated mucosal inflammation characteristic of Crohn disease (CD) in up to one-third of patients with SpA. Video capsule endoscopy (CE) is a superior diagnostic tool to detect small bowel mucosal disease. Our study compared the accuracy of CE to standard colonoscopy for detection of inflammatory bowel lesions in patients with SpA, and to describe predictors of small bowel inflammation (SBI) in this cohort.Methods.Prospective cross-sectional study of adult patients followed for SpA. Patients were evaluated by CE and standard colonoscopy with biopsies. SBI was quantified using the Lewis Score. Additional screening tests included fecal calprotectin (FCP), C-reactive protein (CRP), and a diagnostic panel of serologic, inflammatory and genetic tests (SGI).Results.There were 64 patients recruited (53% female, mean age 42 ± 13 yrs). Chronic gastrointestinal (GI) symptoms were present in 57%. CE revealed significant SBI in 27/64 (42.2%), compared to 7/64 (10.9%) by standard colonoscopy (p = 0.035). Elevated FCP was associated with small bowel CD (OR 4.5, 95% CI 1.01–19.9; p = 0.042). No correlation was observed with presence of GI symptoms, CRP, or SGI results. Finding CD led to a change in management in 65.2% of cases.Conclusion.CE uncovered SBI consistent with CD in 42.2% of patients with SpA, with a significant incremental yield over colonoscopy of 31%. FCP levels were significantly correlated with CE results, while GI symptoms and SGI results were poor predictors of SBI.

Dr. Seidman replies

“…Based on their findings, the authors recommend endoscopic investigation of SpA patients with an elevated FC. Their observation is in keeping with our prospective SpACE Capsule study, which showed that FC was clinically useful in screening for IBD in established SpA 1 . We found that an elevated FC was associated with CD (OR 4.5, sensitivity 74%).…”

“…We are pleased to note the interest that Van Hoovels and colleagues have for our SpACE Capsule study 1 , and read with interest their investigation of the clinical utility of assaying fecal calprotectin (FC) to assist in the diagnosis of spondyloarthritis (SpA) 2 . Rheumatologists traditionally proclaim that the extraarticular manifestations of SpA include inflammatory bowel disease (IBD) 3 .…”

“…No correlation was observed with the presence of GI symptoms, C-reactive protein, or IBD serology. Finding CD in patients with SpA led to a change in management in 65% of cases 1 .…”

Added Value of Fecal Calprotectin to Support the Diagnosis of Spondyloarthropathies

“…If endoscopy and histologic analysis reveal evidence of active CD, therapeutic management of patients with SpA could be changed, by choosing a treatment option that is effective for both CD and SpA (e.g., adalimumab, infliximab, ustekunimab) 10 . In the study by Kopylov, et al, the finding of CD led to a change in patient management in 65.2% of cases 1 . The guidance of SpA management based on FC results is promising and merits further investigation.…”

“…We read with interest the article by Kopylov, et al, who reported small bowel inflammation consistent with Crohn disease (CD) in 42.2% of patients with spondyloarthropathy (SpA) by video capsule endoscopy 1 .…”