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Spondyloarthropathy in inflammatory bowel disease patients on TNF inhibitors
Author(s) -
Subramaniam K.,
Tymms K.,
Shadbolt B.,
Pavli P.
Publication year - 2015
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12891
Subject(s) - medicine , dactylitis , spondyloarthropathy , inflammatory bowel disease , enthesitis , ulcerative colitis , oligoarthritis , psoriasis , psoriatic arthritis , ankylosing spondylitis , sacroiliitis , arthritis , cohort , family history , gastroenterology , disease , immunology , polyarthritis
Abstract Background Musculoskeletal symptoms are the most common extra‐intestinal manifestation associated with inflammatory bowel disease ( IBD ). Spondyloarthritis ( SpA ) is an umbrella term applied to a group of rheumatic diseases with some features in common and others distinct from other inflammatory arthritides. Aim To determine self‐reported prevalence of SpA associated musculoskeletal manifestations in an IBD cohort on tumour necrosis factor ( TNF ) inhibitors using a questionnaire incorporating Assessment of SpondyloArthritis International Society ( ASAS ) criteria. Methods Consecutive IBD patients on TNF inhibitors attending a single IBD centre ( M ay– S eptember 2011) were asked to complete a SpA questionnaire. Data collected included SpA and IBD variables, demographics, concurrent medications, co‐morbidities and autoimmune serology. Results The 140‐patient cohort included 96 suffering from Crohn disease and 44 from ulcerative colitis. The mean age of disease onset was 29.3 years and 45% were men. Concurrent or past history of inflammatory back pain was reported by 29% subjects. Using the imaging and clinical arms of the ASAS criteria, 30% and 14% subjects respectively had axial SpA . Arthritis was reported by 34%, enthesitis 17%, dactylitis 4%, uveitis 6%, psoriasis 6% and a family history of SpA in 39%. Peripheral SpA was present in 41% by the ASAS criteria. There were no differences in these frequencies between Crohn disease and ulcerative colitis. A positive antinuclear antibodies (>1:80) was found in 19% before commencement of TNF inhibitor therapy and increased to 78% on therapy. Clinical drug‐induced lupus erythematosus was uncommon (4%) and was characterised by new clinical signs and symptoms, including arthralgia, rash with elevated dsDNA titres and positive antinuclear antibodies. Conclusions Inflammatory bowel disease patients on TNF inhibitors frequently reported musculoskeletal manifestations. Increased recognition of SpA occurred with use of an SpA self‐reported questionnaire in IBD patients: this could alter management and improve patient outcomes. Clinical drug‐induced lupus erythematosus was uncommon.