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Irritable bowel syndrome symptoms in axial spondyloarthritis more common than among healthy controls: is it an overlooked comorbidity?
  1. Johan Karlsson Wallman1,2,
  2. Elisabeth Mogard1,2,
  3. Jan Marsal3,4,
  4. Kristofer Andréasson1,2,
  5. Anna Jöud5,
  6. Mats Geijer6,7,
  7. Lars Erik Kristensen8,
  8. Elisabet Lindqvist1,2,
  9. Tor Olofsson1,2
  1. 1Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
  2. 2Department of Rheumatology, Skåne University Hospital Lund, Lund, Sweden
  3. 3Department of Clinical Sciences Lund, Gastroenterology, Lund University, Lund, Sweden
  4. 4Department of Gastroenterology, Skåne University Hospital Lund, Lund, Sweden
  5. 5Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
  6. 6Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland and Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
  7. 7Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden
  8. 8Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Parker Institute, Copenhagen, Denmark
  1. Correspondence to Dr Johan Karlsson Wallman, Department of Rheumatology, Skåne University Hospital Lund, Lund 22185, Sweden; johan.81.karlsson{at}gmail.com

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The link between spondyloarthritis and inflammatory bowel disease (IBD) is well-established, with 5%–10% of patients with axial spondyloarthritis (axSpA) having concurrent IBD. Beyond that, ~50%–60% display microscopic gut inflammation,1 and faecal calprotectin (F-calprotectin) is elevated,2 although neither of these findings have been clearly linked to gut symptoms.1 2 Nevertheless, >50% of patients with ankylosing spondylitis (AS) report frequent gut pain/diarrhoea.3 This calls for investigating other potential causes, including irritable bowel syndrome (IBS), for which data in axSpA remain sparse. IBS (general population prevalence ~11%4) is thought to arise through mechanisms similar to fibromyalgia, common in axSpA (affecting up to 25% versus ~2% in the general population).

We aimed to compare the prevalence of gut symptoms meeting ROME III criteria for IBS between patients with axSpA and healthy controls.5 Hence, 182 consecutive patients with well-characterised axSpA without known IBD from the population-based SPARTAKUS study,2 and 50 controls, frequency-matched for sex/age, without rheumatic disease or IBD, were included (online supplementary table S1). For SPARTAKUS protocol/classification algorithm details, see online supplementary file 1.

Supplementary data

[annrheumdis-2019-216134supp001.pdf]

We found that gut symptoms meeting IBS criteria were significantly more frequent among patients with axSpA (30%) than controls (16%; OR: 2.5 (95% CI 1.1 to 5.7); p=0.036) by sex/age-adjusted logistic regression (figure 1A). Additional adjustments for F-calprotectin levels and non-steroidal anti-inflammatory drug (NSAID)-use, respectively, as well as excluding patients/controls reporting ‘alarm symptoms’ (frequent bloody/black stools; unexplained weight-loss), yielded similar OR-estimates for the patients/controls difference (online supplementary file 1).

Figure 1

Proportions of patients with axSpA and controls reporting gut symptoms …

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