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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.
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).
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