Background/Purpose: Inflammatory Bowel Disease (IBD) is a chronic disease that affects up to 0.5% of the population, comprising both Crohn’s Disease (CD) and ulcerative colitis (UC). Various extra-intestinal manifestations can occur, among which spondyloarthritis (SpA). SpA can manifest with both axial and peripheral manifestations, but prevalence estimates of these manifestations differ widely. The objective of this study therefore was to provide a pooled estimate of  the prevalence of axial and peripheral manifestations of SpA in patients with IBD and to identify factors that might influence the prevalence estimates.

Methods: We systematically searched Embase, Pubmed, OvidSP, Scopus and Web-of-science databases from inception to May 2014. All articles addressing the prevalence of axial and/or peripheral manifestations of spondyloarthritis in adult IBD patients were included. Risk of bias was assessed using a quality assessment tool including items on selection bias, non-response bias, sample size and misclassification of SpA diagnosis.

Results: Out of 4846 studies, 60 studies were included. Sample size varied from 9 to 4454. Methodological quality of the included studies was moderate, with only a slight majority scoring positively on the individual items of the quality assessment tool. With regard to axial manifestations, the pooled prevalence of sacroiliitis was 0.11 (95% CI 0.08-0.014), whereas the pooled prevalence for ankylosing spondylitis was 0.03 (95% CI 0.03-0.04). For peripheral arthritis the pooled prevalence was 0.14 (95% CI 0.12-0.16). Few estimates were available for the prevalence of enthesitis (range from 0.01 to 0.54) and dactylitis (range from 0 to 0.04). For both axial and peripheral manifestations, the prevalence was higher in patients with CD than in patients with UC. Heterogeneity between studies was large, which might be explained by methodological quality as well as difference in geographic area, clinical setting and the use of criteria for case ascertainment as shown for the prevalence of SI and AS.

Conclusion: Spondyloarthritis is a common extraintestinal manifestation in IBD. Peripheral arthritis is slightly more common with a pooled prevalence of 0.14 than axial manifestations as sacroiliitis (pooled prevalence 0.11) and ankylosing spondylitis (pooled prevalence 0.03). For both axial and peripheral manifesations, the prevalence is higher in patients with CD than in patients with UC.