Characterization and prevalence of spondyloarthritis and peripheral arthritis among patients with inflammatory bowel disease

Abstract

Background

Joint complaints such as spondyloarthritis and peripheral arthritis are the most common extraintestinal manifestations in patients with inflammatory bowel disease (IBD); however, the evaluation of these symptoms are poorly described.

Objectives

To examine the clinical characteristics and prevalence of ankylosing spondylitis (AS) and other joint complaints among patients with IBD.

Methods

In a local cohort of patients diagnosed with IBD between 1996 and 2009, we performed a retrospective study at the Veterans Affairs Hospital. Patients with IBD were identified by International Classification of Diseases, Ninth Revision codes and confirmed by chart review. The occurrence of AS, peripheral arthritis, and other peripheral and axial joint symptoms were identified.

Results

We identified 626 patients with IBD between ages 18 and 90 (90% males), of whom 57% had ulcerative colitis (UC), 74% were Caucasians, and the mean age at diagnosis was 54 (±16) years. Among the study population, 108 patients (17%) had at least one type of joint pain. Among these 17% with joint pain, 12% had AS, 43% had peripheral arthritis, 32% had chronic back pain without AS, and 13% had other types of joint pain. The overall prevalence of peripheral arthritis among patients with IBD was three times higher than that of AS (7% vs 2.1%, respectively, OR 3.5; 95% confidence interval [CI] 1.9–6.5; p=0.001). There was no difference in the prevalence of AS or peripheral arthritis between patients with Crohn’s disease and UC. The initial diagnosis of AS occurred after the initial diagnosis of IBD in 80% of patients within a mean (SD) period of 5.6 (±6) years.

Conclusion

Spondyloarthritis among patients with IBD is usually diagnosed after the initial diagnosis of IBD. No difference in the prevalence of AS or peripheral arthritis was observed by IBD type, age, or race. Recognition and understanding of these results will have important implications for the management of IBD patients with spondyloarthritis.

Keywords:

• spondyloarthritis
• peripheral arthritis
• inflammatory bowel disease
• extraintestinal manifestations
• Crohn’s disease
• ulcerative colitis
• epidemiology
• risk factors

Acknowledgments

This study was supported UCB Pharm and supported in part with resources at the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), at the Michael E. DeBakey VA Medical Center, Houston, TX, USA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs.

Author contributions

Hoda M Malaty was involved in planning, conducting the study, collecting and interpreting the data, drafting the manuscript, and has approved the final draft submitted.

Jason K Hou was involved in planning, collecting and/or interpreting data, and drafting the manuscript, and has approved the final draft submitted.

Grace Lo was involved in planning and interpreting data, drafting the manuscript, and has approved the final draft submitted.

Disclosure

The authors report no conflicts of interest in this work.