Multicenter Validation of the DETAIL Questionnaire for the Screening of Spondyloarthritis in Patients With Inflammatory Bowel Diseases

Abstract

Objective Spondyloarthritis (SpA) is among the most frequent extra-intestinal manifestations in inflammatory bowel diseases (IBD). In this study, we aimed to validate the DETection of Arthritis in Inflammatory bowel diseases (DETAIL) questionnaire in a multicenter cohort of IBD patients enrolled at eleven Gastroenterology Units. Methods From October 2018 to March 2019, consecutive adult patients with IBD, either Crohn’s disease or ulcerative colitis, filled out independently the DETAIL in the outpatient waiting room. Within two weeks a blinded rheumatologist assessed all the patients, irrespectively of the DETAIL results, and classified them to be affected or not by SpA. The performance of the items was evaluated trough Bayesian analysis. Results Overall, 418 IBD patients filled out the DETAIL questionnaire. Upon rheumatological evaluation, 102 (24.4%) patients received a diagnosis of SpA. Of the six questions, the best performances were found in item 6 (LR+ 3.77), reporting inflammatory back pain at night, and in item 3 (LR+ 3.31), exploring Achilles enthesitis. The presence of back pain lasting more than three months (LR+ 2.91), of back pain with inflammatory features (LR+ 2.55) and a history of dactylitis (LR+ 2.55), showed also a fairly good performance, whereas a history of peripheral synovitis was slightly worse (LR+ 2.16). The combination of at least three items answered affirmatively yields a post-test probability of SpA of 80% or more. The presence of alternative diagnoses, such as osteoarthritis or fibromyalgia, represented a minor confounder. Conclusion The DETAIL questionnaire is a useful tool for the early detection of SpA in IBD.

Screening Tools for Spondyloarthritis in Patients With Psoriasis, Uveitis, and Inflammatory Bowel Disease: A Scoping Review

“…Existing screening tools are limited by their inability to distinguish SpA from other etiologies of musculoskeletal pain, specifically fibromyalgia, osteoarthritis, and degenerative disc disease. 53,[57][58][59][60] One possible explanation for this is the inclusion of nonspecific questions such as, "Do your joints hurt?" and "Have you ever had back troubles?"…”

“…which will yield positive responses in many musculoskeletal disorders and are not discriminatory for SpA. [57][58][59][60] It has been suggested that EARP might be more accurate than other PsA screening tools because it asks specific questions about pain and swelling of joints that are characteristically affected by PsA. 43,44 2.…”

“…Lessons from this scoping review that may aid in developing more robust SpA screening tools include the following: A focus on questions discriminatory for symptoms of SpA may reduce the false‐positive screening rate. Existing screening tools are limited by their inability to distinguish SpA from other etiologies of musculoskeletal pain, specifically fibromyalgia, osteoarthritis, and degenerative disc disease 53,57–60 . One possible explanation for this is the inclusion of nonspecific questions such as, “Do your joints hurt?” and “Have you ever had back troubles?” which will yield positive responses in many musculoskeletal disorders and are not discriminatory for SpA 57–60 .…”

The DETAIL questionnaire is a useful and effective tool to assess spondyloarthritis in patients with inflammatory bowel disease

“…The DETAIL Questionnaire, which was developed later, is a more easily applied test consisting of six questions asking about axial and peripheral arthropathy. The validation study of the DETAIL questionnaire was conducted in a multicentre study and published ( 18 ). In our patient group, peripheral arthropathy was found at an almost similar rate to axial arthropathy in newly diagnosed enteropathic arthritis cases, which is consistent with the literature ( 3 , 19 ).…”

Epidemiology of Musculoskeletal Manifestations in Pediatric Inflammatory Bowel Disease: A Systematic Review

“…With the knowledge that MSK EIMs can often go unrecognized, and the decreased quality of life associated with arthritis in patients with p‐IBD ( 35 ), it is essential that we both increase our research focus in this area and develop methods to appropriately screen for MSK EIMs in p‐IBD. Screening tools are being developed for the adult IBD population to detect MSK EIMs, with some preliminary success ( 36 , 37 , 38 ). The use of appropriate screening in the p‐IBD population would positively impact the detection, diagnosis, and treatment of MSK EIMs.…”