Prevalence of Undiagnosed Inflammatory Bowel Disease in Patients with Spondyloarthritis: EISER Study

Jesus Sanz¹, Zulema Plaza², Jordi Gratacos Masmitja³, Iago Rodríguez -Lago⁴, Elisa Trujillo⁵, Ignacio Marin-Jimenez⁶, Eva Perez-Pampin⁷, Manuel Barreiro de Acosta⁸, Antonio Aznar Esquivel⁹, Marta Carrillo Palau¹⁰, Maria Luz Garcia Vivar¹¹, Maria Carmen Muñoz¹², Lourdes Ladehesa Pineda¹³, Eva Iglesias Flores¹⁴, carolina Merino¹⁵, Yago gonzalez-Lama¹⁶, Marta Arévalo Salaet¹⁷, Xavier calvet¹⁸, Anahy Maria Brandy-Garcia¹⁹, Marta Izquierdo Romero²⁰, SARA MANRIQUE²¹, Raúl Olmedo²², Jose Francisco Garcia Llorente²³, Sandra Pérez²⁴, Inmaculada Ros²⁵, Nuria Rull²⁶, Jose Antonio Pinto Tasende²⁷, Patricia Ucha Abal²⁸, Carlos M González²⁹, Fernando José Rodríguez Martínez³⁰, Soledad Serrano Ladron de Guevara³¹, Marta Domínguez³², Francisco Javier Prado³³, Enrique González-Dávila³⁴ and Ana Gutierrez-Casbas³⁵, ¹Hospital Universitario Puerta de Hierro, Majadahonda, Spain, ²Universidad Autónoma de Madrid, Madrid, Spain, ³University Hospital Parc Taulí, Sabadell, Spain, ⁴Gastroenterology department Hospital Galdakao, Galdakao, Spain, ⁵Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, ⁶Public Health System, Madrid, Spain, ⁷Rheumatology Department Complejo Hospitalario Universitario Santiago, Santiago de compostela, Spain, ⁸Gastroenterology department Complejo Hospitalario Universitario Santiago, Santiago de compostela, Spain, ⁹Rheumatology Department Hospital Universitario Canarias, Santa Cruz de Tenerife, Spain, ¹⁰Gastroenterology department Hospital Universitario Canarias, Santa Cruz de Tenerife, Spain, ¹¹Basurto University Hospital, Bilbao, Spain, ¹²Gastroenterology department Basurto Hospital, Bilbao, Spain, ¹³Rheumatology Department Reina Sofia Universitary Hospital, Cordoba, Spain, ¹⁴Gastroenterology department Hospital Reina Sofia, Cordoba, Spain, ¹⁵Rheumatology Department Hospital Universitario Puerta de Hierro, Majadahonda (Madrid), Spain, ¹⁶Gastroenterology department Hospital Puerta de Hierro Majadahonda, Majadahonda, Spain, ¹⁷Rheumatology Department University Hospital Parc Taulí, Sabadell, Spain, ¹⁸Gastroenterology department University Hospital Parc Taulí, Sabadell, Spain, ¹⁹Hospital Germans Trias i Pujol, Badalona, Spain, ²⁰Gastroenterology department Hospital Cabueñes, Gijon, Spain, ²¹Division of Rheumatology, Hospital Regional Universitario Carlos Haya, Malaga, Spain, ²²Gastroenterology department Hospital Regional Universitario Málaga, Malaga, Spain, ²³Hospital de Gadakao Usansolo Osakidetza, Bilbao, Spain, ²⁴Gastroenterology department Hospital Galdakao, Galdakao, Spain, ²⁵Rheumatology Department HUSLL, Palma de Mallorca, Spain, ²⁶Gastroenterology department HUSLL, Palma de Mallorca, Spain, ²⁷Rheumatology department, Complexo Hospitalario Universitario A Coruña (CHUAC). Instituto de Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain, ²⁸Gastroenterology department Complejo Hospitalario Universitario A Coruña, A Coruña, Spain, ²⁹Rheumatology Department Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, ³⁰Rheumatology Department Hospital Universitario General Santa Lucia, Murcia, Spain, ³¹Gastroenterology department Hospital Universitario General Santa Lucia, Murcia, Spain, ³²Sociedad Española de Reumatología, Madrid, Spain, ³³Research department Hospital Infantil de México Federico Gómez, Mexico City, Mexico, ³⁴Department of Mathematics, Statistics and Operation Reseach La Laguna University, La Laguna, Spain, ³⁵Gastroenterology department Hospital General Universitario de. Dr. Balmis de Alicante Servicio Digestivo. ISABIAL y CIBERehd, Alicante, Spain

Meeting: ACR Convergence 2023

Keywords: Inflammation, Psoriatic arthritis, Spondyloarthropathies

Session Information

Date: Sunday, November 12, 2023

Title: (0483–0509) Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes Poster I: PsA

Session Type: Poster Session A

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

Background/Purpose: EISER is a cross-sectional, multicenter, observational, SER-GETECCU cooperative study involving 13 Spanish hospitals whose main objective was to estimate the prevalence of undiagnosed Inflammatory Bowel Disease (IBD) in patients with spondyloarthritis (SpA), including axial (axSpA) (radiographic axSpA-r and non-radiographic; axSpA-nr) and psoriatic arthritis (PsA).

Methods: We selected patients ≥18 years of age from the NHS Rheumatology Department, SpA diagnosed according to CASPAR criteria for PsA and ASAS for axSpA. Patients under treatment with biologics were excluded. Patients currently treated with systemic steroids or in the previous 30 days were not included. Patients over 50 years of age were included if a colonoscopy wasn’t performed in the last three years or, if a colonoscopy was performed but did not meet the criteria of valid colonoscopy.

Patients were recruited by the rheumatologist who collected demographic, clinical and treatment data. A fecal calprotectin (FC) determination was performed using the Quantum Blue rapid test. FC was assessed and all patients with a FC ≥80 µg/g underwent an endoscopic study by the gastroenterologist. Patients in whom the result of the endoscopic study was normal underwent to an endoscopic capsule study or magnetic resonance imaging.

Results: A total of 559 patients were included, 51.0% of whom were men. The mean age of the participants was 52.2 years, with a mean age at diagnosis of 42 years. Mean time of disease evolution was 12.3 years (Table 1).

Regarding the type of SpA, the most frequent form was axSpA-r (37.0%), followed by peripheral PsA (35.8%; Table 2). Concerning disease activity data in axSpA BASDAI 3.6, ASDAS_PCR 2.3, ASDAS_VSG 2.4 and of patients with PsA DAPSA of 10.4 (Table 2). Global assessment and mean health status reported by patients was 4.1 (0 to 10 scale) and 67.5 (0 to 100 scale; Table 2), respectively.

A total of 47.0% of patients with PsA had FC≥80 µg/g vs. 53% of axSpA (80% axSpA-r vs. 20% axSpA-nr). The mean FC values were higher in the case of axSpA-r (395.06 µg/g) compared to the other groups (305.52 µg/g for the axSpA-nr and 306.19 µg/g for the PsA subgroup).

Overall, 10.0% of the patients had a family history of IBD and 14.6% had clinical manifestations compatible with IBD, the most common clinical manifestations were asthenia (50.0%), abdominal pain (15.6%) and chronic diarrhea (14.1%). A total of 189 colonoscopies were performed (167 in patients with FC≥80 µg/g, of which 39.7% presented some pathological finding, mostly: aphthous ulcers (65.9%), superficial ulcers (20.5%) and mucosal erythema (13.6%), mainly located in terminal ileum (41.3%).

Finally, 23 patients were diagnosed with IBD (4.4%): 22 diagnosed with Crohn’s disease (95%), 1 unclassifiable IBD (5%). Of the 23 patients diagnosed with IBD, 17.4% had a family history of IBD, 30.4% had clinical symptoms compatible with IBD and 82.6% had a colonoscopy with some type of pathological finding.

Conclusion: The finding of elevated fecal calprotectin levels in patients with SpA, followed by an appropriate complementary study (endoscopic and/or radiological), allows the detection of a relevant subgroup of patients who meet diagnostic criteria for IBD.

Table 1: Sociodemographic and general data of all patients included in the study.

Table 2: Type and activity of patients enrolled in the study.

Disclosures: J. Sanz: AbbVie/Abbott, 1, 6, Janssen, 1, 5, 6, Novartis, 6, UCB, 1, 5, 6; Z. Plaza: None; J. Gratacos Masmitja: AbbVie/Abbott, 1, 6, Amgen, 6, AstraZeneca, 6, Bristol-Myers Squibb(BMS), 6, Eli Lilly, 1, 6, Janssen, 1, 6, Novartis, 1, 6, Pfizer, 1, 6, UCB, 1, 6; I. Rodríguez -Lago: None; E. Trujillo: None; I. Marin-Jimenez: None; E. Perez-Pampin: None; M. Barreiro de Acosta: None; A. Aznar Esquivel: None; M. Carrillo Palau: None; M. Garcia Vivar: None; M. Muñoz: None; L. Ladehesa Pineda: None; E. Iglesias Flores: None; c. Merino: None; Y. gonzalez-Lama: AbbVie/Abbott, 1, 6, Janssen, 1, 6, Pfizer, 1, 6; M. Arévalo Salaet: None; X. calvet: None; A. Brandy-Garcia: None; M. Izquierdo Romero: None; S. MANRIQUE: None; R. Olmedo: None; J. Garcia Llorente: AbbVie/Abbott, 6, Amgen, 5, Bristol-Myers Squibb(BMS), 6, Eli Lilly, 6, Faes, 11, galápagos, 6, Gebro pharma, 5, UCB, 5; S. Pérez: None; I. Ros: Janssen, 6, novartis, 6, Pfizer, 6; N. Rull: None; J. Pinto Tasende: None; P. Ucha Abal: None; C. González: None; F. Rodríguez Martínez: None; S. Serrano Ladron de Guevara: None; M. Domínguez: None; F. Prado: None; E. González-Dávila: None; A. Gutierrez-Casbas: None.

To cite this abstract in AMA style:

Sanz J, Plaza Z, Gratacos Masmitja J, Rodríguez -Lago I, Trujillo E, Marin-Jimenez I, Perez-Pampin E, Barreiro de Acosta M, Aznar Esquivel A, Carrillo Palau M, Garcia Vivar M, Muñoz M, Ladehesa Pineda L, Iglesias Flores E, Merino c, gonzalez-Lama Y, Arévalo Salaet M, calvet X, Brandy-Garcia A, Izquierdo Romero M, MANRIQUE S, Olmedo R, Garcia Llorente J, Pérez S, Ros I, Rull N, Pinto Tasende J, Ucha Abal P, González C, Rodríguez Martínez F, Serrano Ladron de Guevara S, Domínguez M, Prado F, González-Dávila E, Gutierrez-Casbas A. Prevalence of Undiagnosed Inflammatory Bowel Disease in Patients with Spondyloarthritis: EISER Study [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/prevalence-of-undiagnosed-inflammatory-bowel-disease-in-patients-with-spondyloarthritis-eiser-study/. Accessed .

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