The Prevalence and Incidence of Axial and Peripheral Spondyloarthritis in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Karreman, M.C.; Luime, Jolanda J.; Hazes, Johanna M. W.; Weel, A.

doi:10.1093/ecco-jcc/jjw199

Cited by 121 publications

(151 citation statements)

References 70 publications

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“… Although back pain is often the main complaint in axial spondyloarthritis, only 5% of patients with chronic back pain have underlying axial spondyloarthritis . However, the prevalence of axial spondyloarthritis is higher in patients with chronic back pain and a closely related disease, such as IBD …”

Section: Resultsmentioning

confidence: 99%

“…Peripheral arthritis prevalence in IBD patients has been estimated at 13%, being highest (25%) in 20‐30‐year‐old patients . Arthritis is characterised by swelling and pain, but redness and warmth are also frequent.…”

Section: Resultsmentioning

confidence: 99%

“…In some patients, axial spondyloarthritis evolves into ankylosing spondylitis, a more severe disease stage with structural damage of the sacroiliac joints and/or spine visible on X‐ray . The main symptoms of peripheral spondyloarthritis are arthritis, enthesitis and dactylitis …”

Section: Introductionmentioning

confidence: 99%

“…10,11 The main symptoms of peripheral spondyloarthritis are arthritis, enthesitis and dactylitis. 12 A recent meta-analysis has shown that up to 13% of IBD patients are diagnosed with peripheral arthritis, whereas prevalence estimates for sacroiliitis and ankylosing spondylitis are 10% and 3%, respectively. 12 Joint flares usually, but not exclusively, accompany gut flares.…”

Section: Introductionmentioning

confidence: 99%

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Expert consensus: practical algorithms for management of inflammatory bowel disease patients presenting with back pain or peripheral arthropathies

Varkas

Ribbens

Louis

et al. 2019

Aliment Pharmacol Ther

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Summary Background Spondyloarthritis is the most frequent extra‐intestinal manifestation of IBD. Aim To present simple strategies to identify and differentiate inflammatory joint pain in IBD patients. Methods A panel of Belgian gastroenterologists and rheumatologists developed seven algorithms for IBD patients with joint symptoms based on a Delphi exercise conducted between April and December 2016. Here, we focus on referral strategies for patients with chronic back pain (evidence‐based strategy), large joint monoarthritis, oligo‐ or polyarticular arthritis or arthralgia (based on expert opinion). We also present management tools for IBD patients with acute back pain and small joint monoarthritis (Supplementary file). Results The reported algorithm for IBD patients with chronic back pain uses basic clinical criteria to identify which patients should be referred to the emergency room (spondylodiscitis), physical medicine and rehabilitation (mechanical back pain) or rheumatologist (spondyloarthritis). IBD patients with large joint monoarthritis should be referred to emergency room if septic arthritis is suspected; in other patients, blood analyses and referral to a rheumatologist for articular puncture with evacuation of synovial fluid are recommended. The analysis of synovial fluid allows for identification of non‐inflammatory (e.g., osteoarthritis) and inflammatory (e.g., [pseudo]‐gout, peripheral spondyloarthritis and Borrelia burgdorferi arthritis) conditions. In patients with inflammatory oligoarticular or polyarticular arthralgia, erythrocyte sedimentation rate, concomitant therapies, anti‐nuclear factor and anti‐double‐stranded DNA antibody levels should be evaluated; in anti‐tumour necrosis factor‐treated patients, a drug‐induced lupus‐like syndrome should be considered. Conclusion We propose straightforward strategies for IBD patients with joint symptoms, which are specific enough to select initial treatment and referral pattern.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Expert consensus: practical algorithms for management of inflammatory bowel disease patients presenting with back pain or peripheral arthropathies

Varkas

Ribbens

Louis

et al. 2019

Aliment Pharmacol Ther

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“…Yet, therapeutic benefits on quality of life are important to patients, and knowledge regarding such benefits may be an important tool in improving compliance in real-world scenarios. 1 For this reason, Younossi and colleagues are to be commended for their study, which describes clinically significant improvements in almost all measured physical and mental health-related quality of life outcomes following therapy with sofosbuvir and velpatasvir with or without voxilaprevir. 2 This replicates findings from other direct-acting antiviral regimens, but also confirms our own observations from clinical experience using these drugs.…”

Section: Editorial: Direct-acting Antivirals Significantly Improve Qumentioning

confidence: 99%

Editorial: vedolizumab as a treatment and cause of extra‐intestinal manifestations of inflammatory bowel disease

Barclay

Stamp

2018

Aliment Pharmacol Ther

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Conversely, however, 13.8% of those without joint involvement at baseline developed joint pain, albeit mostly arthralgia rather than frank arthritis, and 4.8% had paradoxical skin manifestations. The paradoxical occurrence of joint symptoms with vedolizumab has been reported previously in case series and is not unique to this drug having been reported with anti-TNF therapies. 5,6 Likewise, cutaneous adverse effects such as psoriaform lesions and eczema are recognised with anti-TNF drugs with a similar rate as seen in this study with vedolizumab. 7 It is not yet clear whether these adverse manifestations relate mostly to the specific actions of both types of drug including the balance of cytokines, or are non-specific and due more to their monoclonal antibody structure and potential for induction of autoantibodies. Distinguishing these mechanisms will be important for the future of monoclonal antibody drugs.

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Management of Crohn Disease

Cushing

Higgins

2021

JAMA

197

117

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ImportanceCrohn disease, a chronic gastrointestinal inflammatory disease, is increasing in incidence and prevalence in many parts of the world. Uncontrolled inflammation leads to long-term complications, including fibrotic strictures, enteric fistulae, and intestinal neoplasia. Therefore, early and effective control of inflammation is of critical importance.ObservationsThe optimal management approach for Crohn disease incorporates patient risk stratification, patient preference, and clinical factors in therapeutic decision-making. First-line therapy generally consists of steroids for rapid palliation of symptoms during initiation of anti–tumor necrosis factor α therapy. Other treatments may include monoclonal antibodies to IL-12/23 or integrin α4β7, immunomodulators, combination therapies, or surgery. Effective control of inflammation reduces the risk of penetrating complications (such as intra-abdominal abscesses and fistulae), although more than half of patients will develop complications that require surgery. Adverse reactions to therapy include antibody formation and infusion reactions, infections, and cancers associated with immune modulators and biologics and toxicity to the bone marrow and the liver. Both Crohn disease and corticosteroid use are associated with osteoporosis. Vaccinations to prevent infections, such as influenza, pneumonia, and herpes zoster, are important components of health maintenance for patients with Crohn disease, although live vaccines are contraindicated for patients receiving immune suppression therapy.Conclusions and RelevanceThe treatment of patients with Crohn disease depends on disease severity, patient risk stratification, patient preference, and clinical factors, including age of onset and penetrating complications, and includes treatment with steroids, monoclonal antibody therapies, immunomodulators, and surgery. Physicians should be familiar with the advantages and disadvantages of each therapy to best counsel their patients.

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The Prevalence and Incidence of Axial and Peripheral Spondyloarthritis in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Abstract: Spondyloarthritis occurs in up to 13% of patients with IBD. Ankylosing spondylitis is the least common [3%] followed by sacroiliitis [10%] and peripheral arthritis [13%].

Cited by 121 publications

References 70 publications

Expert consensus: practical algorithms for management of inflammatory bowel disease patients presenting with back pain or peripheral arthropathies

Expert consensus: practical algorithms for management of inflammatory bowel disease patients presenting with back pain or peripheral arthropathies

Editorial: vedolizumab as a treatment and cause of extra‐intestinal manifestations of inflammatory bowel disease

Management of Crohn Disease

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