Significant Rate of Undiagnosed axSpA Among Patients at IBD Clinics

An estimated 5% of patients at secondary care inflammatory bowel disease (IBD) clinics who had back pain had undiagnosed, rheumatology-verified axial spondyloarthritis (axSpA), according to study results published in Rheumatology.

The study included 470 patients from IBD clinics at a university teaching hospital. Each patient had a gastroenterologist-verified IBD diagnosis and had never been on biologic therapy or been diagnosed with axSpA. Among them, 91 patients had more than 3 months of self-reported chronic back pain that began before age 45, signaling a moderate diagnostic probability of axSpA.

A total 82 patients participated in a clinical assessment for axSpA, which consisted of a medical review, physical exam, patient-reported outcome measures, human leucocyte antigen B27 and C-reactive protein testing, pelvic radiograph, and magnetic resonance imaging.

Based on assessment findings, a panel of rheumatologists determined an estimated 5% of patients had undiagnosed axSpA, according to the study. On average, patients had experienced symptoms for 12 years.

“There is a significant hidden disease burden of axSpA among IBD patients,” wrote researchers from the Norfolk and Norwich University Hospitals NHS Foundation Trust in the United Kingdom. “Appropriate identification and referral from gastroenterology is needed to potentially shorten the delay to diagnosis and allow access to appropriate therapy.”

Reference
Lim CSE, Tremelling M, Hamilton L, et al. Prevalence of undiagnosed axial spondyloarthritis in inflammatory bowel disease patients with chronic back pain: secondary care cross-sectional study. Rheumatology. 2023;62(4):1511-1518. doi: 10.1093/rheumatology/keac473