Background Inflammatory Bowel Disease associated arthropathy (IBD-aA) can cause impaired function but the level of activity limitations in comparison with other subgroups of spondyloarthritis (SpA) is unknown. Furthermore, data on the association of IBD-aA with the severity of bowel disease is limited.
Objectives To compare disease severity as measured by patient reported outcome (PROMs): 1) in patients with IBD-aA with peripheral and axial musculoskeletal manifestations to those in Ankylosing Spondylitis (AS) and Psoriatic Arthritis (PsA) respectively, 2) by severity of IBD-aA reflected by whether second line treatment had be given.
Methods The SpA Scania cohort consists of all the subjects aged 15 years or older in the Skåne region (1.2 million inhabitants in southern Sweden) having recieved a diagnosis of any type of Spondyloarthritis during 2003-2007 at primary or specialised care visits (N=5771) recorded in the Skåne Health Care Register (SHCR). This included patients with Ankylosing Spondylitis (26%), Undiffentiated Spondyloarthritis (22%), Psoriatic Arthritis (39%) and IBD-aA (2.3%). A postal questionnaire was sent in 2009 to all the subjects aged 15 years or older including questions on PROMs with an overall response rate of 58%. Of the 65 patients with IBD-aA responding to the questionnaire a structured review of medical records verified both IBD and arthritis in 80% (N=52), from whom questionnaire data was used in the present analyses. The occurrence of axial or peripheral musculoskeletal disease and given second line therapy (surgery or treatment with TNF-inhibitor for IBD) were retrieved through the medical record review.
Results Fifty-two patients records were analysed (17 men, mean age 39.8). Patients with axial IBD-aA (N=23) had comparable values for BASDAI (4.8 vs 4.0, p=0.19) and BASFI (4.1 vs 3.4, p=0.44) to AS patients (N=711). Patients with peripheral IBD-aA (N=44) had comparable values for global health (numeric rating scale) (4.5 vs 4.1, p=0.51) compared to PsA patients (N=1225). Severe bowel disease, defined as the need of anti-TNFa therapy or surgery, was observed in 52% (n=27) of the patients with IBD-aA. Perceived health according to PROMs was similar in the patients with and without severe IBD (BASDAI: 5.1 vs 4.9 p=0.71, BASFI: 4.5 vs 3.3 p=0.13, global health: 4.8 vs 4.2 p=0.29).
Conclusions Patients with IBD-aA tend to have worse perceived health compared to patients with AS and PsA. This warrants further and larger studies of this subgroup of SpA.
Disclosure of Interest None declared