ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 1309

Prevalence of Undiagnosed Axial Spondyloarthritis Among Patients with Inflammatory Bowel Disease: A Secondary Care Cross-Sectional Study

Chong Seng Edwin Lim1, Mark Tremelling1, Louise Hamilton1, Alexander MacGregor1, Tom Turmezei1, Matthew Kim1 and Karl Gaffney2, 1Norfolk and Norwich University Hospital, Norwich, United Kingdom, 2Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, United Kingdom

Meeting: ACR Convergence 2020

Keywords: Ankylosing spondylitis (AS), Diagnostic criteria, Inflammation, Spondylarthropathies, spondyloarthritis

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Date: Sunday, November 8, 2020

Title: Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes Poster II: Extra-MSK & Comorbidities

Session Type: Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Axial spondyloarthritis (axSpA) is closely related to inflammatory bowel disease (IBD), however contemporary data on the burden of hidden disease in the IBD population is lacking. This is despite significant advances in imaging and improved understanding of the axSpA disease spectrum. Recognition of the association between axSpA and IBD is important in order to bridge the gap of diagnostic delay and streamline referral for treatment. This study aims to elucidate the hidden prevalence of axSpA in IBD patients in secondary care.

Methods: Screening questionnaires were sent to consecutive IBD patients attending routine clinics (September 2017 to February 2019) in a large teaching hospital serving an estimated 3000 IBD patients. Patients fulling the eligibility criteria (gastroenterologist-verified diagnosis, 18 to 80 years old, biologic therapy naïve, no previous diagnosis of axSpA); and a moderate-diagnostic-probability of axSpA (self-reported chronic-back-pain (CBP) onset before 45 years old) were invited for rheumatological assessment. This included a medical interview, physical examination (including joint and tender point count, MASES, dactylitis count, BASMI), patient reported outcomes (BASDAI, BASFI, BASGI, Harvey-Bradshaw-Index, Partial-Mayo-Index), relevant laboratory tests (CRP, ESR, HLA-B27), pelvic radiograph, axSpA protocol MRI, and remote review by a panel of expert axSpA rheumatologists.

Results: The prevalence of rheumatologist-verified diagnosis of axSpA was 5% (95% CI 1.3,12.0) with a mean delay to diagnosis of 12 (S.D. 12.4) years. Using contemporary classification criteria, the prevalence of axSpA was 39% (ESSG), 12% (ASAS), (mNYC) respectively. Of the 470 patients approached, 41% (n=191) responded. Of the 173 valid completed questionnaires, 53% (n=91) had CBP onset < 45 yr and 90% (n=82) attended for clinical assessment. The mean age was 52 yr, 37% male. 74% ulcerative colitis, 26% crohn’s disease, 66% disease remission. The prevalence of physician verified inflammatory back pain (IBP) was 20%. However, 38%, 35%% and 29% fulfilled Calin, Berlin and ASAS classification criteria respectively. Previous history of acute anterior uveitis (AAU), skin psoriasis, other peripheral musculoskeletal (MSK) axSpA manifestations were reported by 5%, 7% and 16% respectively. Thirty-five percent (n=29) had a positive family history of axSpA-related conditions (62% IBD, 52% skin psoriasis, 4% axSpA). Mean CRP and ESR were 4.3mg/L and 14mm/h respectively; 7% HLA-B27 positive; 4% ASAS positive MRI (active sacroiliitis); 6% fulfilled mNYC radiological criteria.

Conclusion: The hidden prevalence of rheumatologist-verified diagnosed axSpA in IBD patients seen routinely in a hospital setting with self-reported CBP which started before 45 years old is conservatively estimated at 5%. This represents a significant hidden disease burden. Greater awareness and education are still needed.  We need to get it right first time by appropriate identification and referral from gastroenterology to rheumatology, in order to potentially shorten the delay to diagnosis and allow access to effective therapy.


Disclosure: C. Lim, None; M. Tremelling, None; L. Hamilton, None; A. MacGregor, None; T. Turmezei, None; M. Kim, None; K. Gaffney, Abbvie, 2, 5, 8, Celgene, 2, 5, 8, Lilly, 2, 5, 8, Pfizer, 2, 5, 8, Gilead, 2, 5, 8, MSD, 2, 5, 8, Novartis, 2, 5, 8, UCB, 2, 5, 8.

To cite this abstract in AMA style:

Lim C, Tremelling M, Hamilton L, MacGregor A, Turmezei T, Kim M, Gaffney K. Prevalence of Undiagnosed Axial Spondyloarthritis Among Patients with Inflammatory Bowel Disease: A Secondary Care Cross-Sectional Study [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/prevalence-of-undiagnosed-axial-spondyloarthritis-among-patients-with-inflammatory-bowel-disease-a-secondary-care-cross-sectional-study/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-undiagnosed-axial-spondyloarthritis-among-patients-with-inflammatory-bowel-disease-a-secondary-care-cross-sectional-study/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology