Clinical Characteristics of Patients with SpA and Concomitant IBD: Results from the ASAS PerSpA Study

Keisuke Ono¹, Mitsumasa Kishimoto², Gautam Deshpande³, Sho Fukui⁴, Satoshi Kawaai⁵, Haruki Sawada⁶, Minoru Matsuura⁷, Valeria Rios Rodriguez⁸, Fabian Proft⁸, Kurisu Tada⁶, Naoto Tamura⁶, Yoshinori Taniguchi⁹, Ayako Hirata¹⁰, Hideto Kameda¹⁰, Shigeyoshi Tsuji¹¹, Yuko Kaneko¹², Hiroaki Dobashi¹³, Tadashi Okano¹⁴, Yoichiro Haji¹⁵, Akimichi Morita¹⁶, Akihiko Asahina¹⁷, Masato Okada¹⁸, Yoshinori Komagata¹, Clementina López Medina¹⁹, Anna Molto²⁰, Désirée van der Heijde²¹, Maxime Dougados²², Tadakazu Hisamatsu⁷, Tetsuya Tomita²³ and Shinya Kaname¹, ¹Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan, ²Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Yokohama, Japan, ³Department of General Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan, ⁴Immuno-Rheumatology Center, St. Luke’s International Hospital, and Center for clinical epidemiology, St. Luke’s International University, Tokyo, Japan, ⁵Immuno-Rheumatology Center, St. Luke’s International Hospital, Tokyo, Japan, Chuo-ku, Tokyo, Japan, ⁶Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan, ⁷Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan, ⁸Charité University Medicine Berlin, Berlin, Germany, ⁹Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi, Japan, ¹⁰Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan, ¹¹Department of Orthopedics and Rheumatology, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan, ¹²Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan, ¹³Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kita-gun, Japan, ¹⁴Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan, ¹⁵Department of Rheumatology, Daido Hospital, Nagoya, Japan, ¹⁶Department of Geriatric and Environmental Dermatology, Nagoya City University, Nagoya, Japan, ¹⁷Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan, ¹⁸Immuno-Rheumatology Center, St. Luke’s International Hospital, Tokyo, Japan, ¹⁹Department of Rheumatology, Reina Sofia Hospital, IMIBIC, University of Cordoba, Cordoba, Spain/ Department of Rheumatology, University of Paris, Cochin Hospital, Paris, France, ²⁰Rheumatology department, Cochin hospital, APHP, Paris, France, ²¹Department of Rheumatology, Leiden University Medical Center, Meerssen, Netherlands, ²²Université de Paris . Department of Rheumatology - Hôpital Cochin. Assistance Publique - Hôpitaux de Paris . INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité. Paris, France., Paris, France, ²³Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita Osaka, Japan

Meeting: ACR Convergence 2021

Keywords: spondyloarthritis

Session Information

Date: Monday, November 8, 2021

Title: Spondyloarthritis Including PsA – Diagnosis, Manifestations, & Outcomes III: Comorbidities, Extra-muskuloskeletal Manifestations, & Related Conditions (1304–1328)

Session Type: Poster Session C

Session Time: 8:30AM-10:30AM

Background/Purpose: A recent study reports that gut inflammation is linked to degree of bone marrow edema in sacroiliac joints in patients with axial spondyloarthritis (SpA). SpA patients with concomitant inflammatory bowel disease (IBD) typically have more severe disease requiring aggressive treatment. However, the clinical characteristics of SpA patients with IBD has not been shown in a large cohort and there are few descriptions of regional differences.

The purpose of this study is to clarify the clinical characteristics of SpA patients with IBD compared to those SpA patients without IBD. In addition, we aim to determine the phenotype of patients given a definitive diagnosis of IBD-associated SpA by their treating rheumatologist.

Methods: Using ASAS-PerSpA data, an observational study, we analyzed information on demographics and disease characteristics, dichotomizing patients by IBD status. SpA patients with IBD were further categorized by region; Japan, non-Japan Asia, and non-Asian countries. SpA patients with IBD were also categorized as IBD-associated SpA or other SpA with IBD by their rheumatologists.

Results: Among 4465 SpA patients included in the study, 287 were identified with IBD. Compared to those without IBD, SpA patients with IBD were less likely male (54.0 vs 61.5%) and more likely to have experienced diagnostic delay (5.1 vs 2.9 years) (Table 1). SpA patients with IBD had lower prevalence of positive HLA-B27 (37.2% vs 68.0%) and less dactylitis (9.1% vs 15.8%) despite similar rates of other peripheral signs. Disease activity, radiographic sacroiliitis and inflammation on MRI were similar in the two groups. csDMARDs and bDMARDs use was higher in SpA patients with IBD.

With respect to regional differences, SpA patients with IBD was more common in Japan than in both non-Japan Asia and non-Asian countries (13.2, 1.7 and 7.1%, respectively). SpA patients with IBD in Japan experienced more diagnostic delay (12.8, 0.3 and 5.0 years, respectively), had lower prevalence of positive HLA-B27 (0, 81.8 and 36.2%, respectively) and less axial symptom (inflammatory back pain: 57.7, 84.6 and 81.9%, radiographic sacroiliitis: 23.1,46.2 and 60.9%, sacroiliitis on MRI: 33.3, 83.3 and 71.3%, respectively).

SpA patients with IBD were categorized by rheumatologists into their respective clinical diagnoses, of which 111 were diagnosed with IBD-associated SpA (Figure 1). IBD-associated SpA patients, compared to those diagnosed as primarily SpA patients with IBD but not IBD-associated SpA, had lower prevalence of both HLA-B27 (19.3 vs 45.2%) and family history of SpA (24.3 vs 39.8%) (Table 2). IBD-associated SpA patients had fewer axial symptom and signs, and were more likely to have peripheral arthritis – especially oligoarthritis. In IBD-associated SpA patients, IBD appears more often as the first symptom of SpA, and IBD-specific treatment was needed more frequently. csDMARDs use was higher in IBD-associated SpA.

Conclusion: SpA patients with IBD required more specific treatments than those without IBD. In SpA patients with IBD, rheumatologists tended to diagnose IBD-associated SpA in those without axial signs but with peripheral signs, and those with IBD as the initial symptom and requiring IBD-specific treatment.

Table 1. Clinical Characteristics of SpA patients with IBD.

Figure 1. Final clinical diagnosis of SpA patients with IBD patients by rheumatologists. (N&#3f287)

Table 2. Clinical Characteristics of IBD-associated SpA compared to other SpA patients with IBD.

Disclosures: K. Ono, a, 1; M. Kishimoto, AbbVie, 2, 6, Amgen-Astellas BioPharma, 2, 6, Asahi-Kasei Pharma, 2, 6, Astellas, 2, 6, Ayumi Pharma, 2, 6, BMS, 2, 6, Chugai, 2, 6, Daiichi-Sankyo, 2, 6, Eisai, 2, 6, Eli Lilly, 2, 6, Gilead, 2, 6, Janssen, 2, 6, Kyowa Kirin, 2, 6, Novartis, 2, 6, Ono Pharma, 2, 6, Pfizer, 2, 6, Tanabe-Mitsubishi, 2, 6, Teijin Pharma, 2, 6, UCB Pharma, 2, 6; G. Deshpande, None; S. Fukui, None; S. Kawaai, None; H. Sawada, None; M. Matsuura, Janssen Pharmaceutical K.K., 2, 6, Takeda Pharmaceutical Co. Ltd., 2, 6, AbbVie GK, 2, 6, Mitsubishi Tanabe Pharma Corporation, 2, 6, Kyorin Pharmaceutical Co. Ltd., 2, 6, Mochida Pharmaceutical Co., Ltd., 2, 6, JIMRO Co., 2, 6, Nippon Kayaku Co. Ltd., 2, 6, Mylan EPD G.K., 2, 6, Aspen Japan Co. Ltd., 2, 6; V. Rios Rodriguez, None; F. Proft, Novartis, 6; K. Tada, None; N. Tamura, AbbVie Japan GK, 6, Bristol-Myers Squibb Co. Ltd, 6, Chugai Pharmaceutical Co. Ltd, 6, Eisai Co. Ltd, 6, Eli Lilly Japan K.K, 6, Glaxo Smith Kline K.K., 6, Janssen Pharmaceutical K.K., 6, Mitsubishi-Tanabe Pharma Co., 6, Novartis Pharma K.K, 6; Y. Taniguchi, None; A. Hirata, None; H. Kameda, Asahi-Kasei, 2, 5, 6, Novartis, 2, 5, 6, AbbVie, 2, 5, 6, Chugai, 5, 6, Mitsubishi-Tanabe, 5, 6, Astellas, 2, Eli Lilly, 2, 6, Pfizer, 6, Eisai, 5, 6, Gilead Sciences, 2, Janssen, 2, 6, Sanofi, 2, UCB, 2; S. Tsuji, None; Y. Kaneko, None; H. Dobashi, None; T. Okano, None; Y. Haji, None; A. Morita, None; A. Asahina, Sun Pharmaceutical Industries, Inc., 5, 6, AbbVie, 5, 6, Janssen, 5, 6, Celgene, 5, 6, Eisai, 5, 6, Kyowa Kirin, 5, 6, LEO Pharma, 5, 6, Maruho, 5, 6, Mitsubishi Tanabe Pharma, 5, 6, Taiho Pharma, 5, 6, Torii Pharmaceutical, 5, 6, UCB, 5, 6, Eli Lilly Japan, 5, 6; M. Okada, AbbVie, 2, Eli Lilly, 2, AbbVie Japan, 6, Eli Lilly and Company, 6, Ono Pharmaceutical, 6; Y. Komagata, None; C. López Medina, None; A. Molto, None; D. van der Heijde, AbbVie, 2, Amgen, 2, Astellas, 2, AstraZeneca, 2, Bayer, 2, BMS, 2, Boehringer Ingelheim, 2, Celgene, 2, Cyxone, 2, Daiichi, 2, Eisai, 2, Eli Lilly, 2, Galapagos, 2, Gilead, 2, GlaxoSmithKline, 2, Janssen, 2, Merck, 2, Novartis, 2, Pfizer, 2, Regeneron, 2, Roche, 2, Sanofi, 2, Takeda, 2, UCB Pharma, 2, Imaging and Rheumatology BV, 4; M. Dougados, AbbVie, 2, 5, Bristol-Myers Squibb, 2, 5, Eli Lilly, 2, 5, Merck, 2, 5, Novartis, 2, 5, Pfizer Inc, 2, 5, Roche, 2, 5, UCB, 2, 5; T. Hisamatsu, Alfresa Pharma Co., Ltd., 5, Mitsubishi Tanabe Pharma Corporation, 2, 5, 6, EA Pharma Co., Ltd., 2, 5, 6, AbbVie GK, 2, 5, 6, JIMRO Co., Ltd., 2, 5, 6, Zeria Pharmaceutical Co., Ltd., 5, Daiichi-Sankyo, 5, Nippon Kayaku Co., Ltd., 5, Pfizer Inc., 2, 5, 6, Mochida Pharmaceutical Co., Ltd., 2, 5, 6, Celgene K.K., 2, 6, Kyorin Pharmaceutical Co. Ltd., 2, 5, 6, Janssen Pharmaceutical K.K., 2, 6, Takeda Pharmaceutical Co., Ltd., 2, 5, 6; T. Tomita, None; S. Kaname, None.

To cite this abstract in AMA style:

Ono K, Kishimoto M, Deshpande G, Fukui S, Kawaai S, Sawada H, Matsuura M, Rios Rodriguez V, Proft F, Tada K, Tamura N, Taniguchi Y, Hirata A, Kameda H, Tsuji S, Kaneko Y, Dobashi H, Okano T, Haji Y, Morita A, Asahina A, Okada M, Komagata Y, López Medina C, Molto A, van der Heijde D, Dougados M, Hisamatsu T, Tomita T, Kaname S. Clinical Characteristics of Patients with SpA and Concomitant IBD: Results from the ASAS PerSpA Study [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/clinical-characteristics-of-patients-with-spa-and-concomitant-ibd-results-from-the-asas-perspa-study/. Accessed .

« Back to ACR Convergence 2021

ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-characteristics-of-patients-with-spa-and-concomitant-ibd-results-from-the-asas-perspa-study/