Background/Purpose:

Inflammatory bowel disease (IBD) is a classical extra articular feature of spondyloarthritis (SpA), with increasing evidence of a pathophysiological relationship.

The aims of this study were to evaluate in the DESIR cohort (1) The prevalence of IBD at baseline, and factors (epidemiological, clinical, imaging, biological data available in the database) associated with IBD, (2) The occurrence of new cases of IBD during the M0-M60 follow-up, and factors associated.

Methods:

DESIR is a prospective observational cohort of patients with recent onset (less than 3 years) inflammatory back pain, beginning before 50 years, suggestive of axial SpA, with a planned follow up of ten years. At baseline : identification of patients with IBD (with medical confirmation), analysis of factors (clinical, biological, imaging, treatment) associated with IBD : comparison of patients with and without IBD, for categorical variables : odds-ratio +/- 95% CI and chi-square/Fisher tests, for continuous variables : unpaired t-tests / Mann-Whitney, in uni and then multivariate analysis (logistic regression). Occurrence of new cases of IBD over the five first years of follow-up (database locked on june 20^th 2016), and factors associated with IBD at M60 were assessed using uni- and multivariate analysis by logistic regression. Significance : p less than 0.05.

Results:

At baseline, 706 patients were analyzed, 35 had a past history or a concomitant IBD : prevalence 4.94% [CI 95% : 3.3 – 6.5]. IBD was significantly associated (univariate) with ESSG criteria (OR = infinite [2.8-infinite], familial history of IBD (OR = 3.56 [1.01-110.22]) and negatively associated with psoriasis (OR = 0.09 [0.02-0.24]), HLA-B27 (OR = 0.47 [0.21-0.98]) and NSAID score (mean 30.25 (IBD) versus 45.49; p = 0.005). In multivariate analysis IBD was associated positively with familial history of IBD (OR = 5.69 [3.57-7.82]) and negatively with psoriasis (OR = 0.04 [0.035-0.048]) and HLA-B27 (OR = 0.28 [0.26-0.31]). IBD was not associated with phenotypic presentation (peripheral arthritis, enthesitis, dactylitis, uveitis) or baseline serum levels of cytokines (TNF, IL-6, IL-17 A, IL-17 F, IL-23, IL-23). At M60, 617 patients were analyzed, 58 with IBD : prevalence 9.4 %. 23 incident cases of IBD were recorded, giving an estimated occurrence rate of 0.7/100 patient-years in this population. In univariate analysis on prevalent cases, IBD was associated with lower NSAID score (mean 17 versus 19.9, p = 0.029) and a less frequent NSAID response (OR = 0.30 0.13-0.76]), worse activity and function indexes (ASDAS-CRP mean 2.28 versus 2.02; p = 0.038, BASFI mean 29 versus 22; p = 0.019, SF-36 mean 39 versus 44; p = 0.004, HAQ mean 0.75 versus 0.5; p = 0.004, ASQoL mean 8.7 versus 6.6; p = 0.012), and with more family history of IBD (OR = 6.6 [1-40]), more sick leave (mean 21 versus 11 days; p = 0.029), and fulfillment of ESSG criteria. In multivariate analysis, IBD was associated with fulfillment of modified New York criteria (p = 0.04).

Conclusion:

IBD occurs with a rate of 0.7/100 patient-years over 5 years in DESIR cohort, with a negative association at baseline with psoriasis and HLA-B27. At five years, IBD is associated with more severe disease and classification criteria.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-inflammatory-bowel-disease-in-early-spondyloarthritis-in-a-prospective-longitudinal-cohort/