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Vladimirova N, Terslev L, Attauabi M, Madsen G, Fana V, Wiell C, Døhn UM, Bendtsen F, Seidelin J, Burisch J, Østergaard M. Peripheral Joint and Enthesis Involvement in Patients With Newly Diagnosed Inflammatory Bowel Disease: Symptoms, and Clinical and Ultrasound Findings - A Population-Based Cohort Study. J Crohns Colitis 2024; 18:1053-1070. [PMID: 38366120 DOI: 10.1093/ecco-jcc/jjae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES Musculoskeletal [MSK] manifestations in patients with inflammatory bowel disease [IBD] are common and associated with poorer outcomes. Hence, early detection is important to optimally tailor treatment. We aimed to determine the prevalence and distribution of inflammatory lesions in peripheral joints and entheses in newly diagnosed IBD patients. DESIGN Patients with newly diagnosed IBD from a prospective population-based inception cohort were consecutively included. Data on MSK symptoms were collected by questionnaires and by structured rheumatological interview. Peripheral joints and entheses were assessed clinically and by ultrasound [US], using standardized definitions. RESULTS Of 110 included patients (mean age: 42 years, 40% male, 70 with ulcerative colitis [UC], 40 with Crohn's disease [CD]), a history of ≥1 peripheral musculoskeletal symptom was reported by 49%. Clinical examination revealed peripheral MSK manifestations in 56 [52.3%] patients; 29 [27.1%] had ≥1 tender and/or swollen joints and 49 [45.8%] ≥1 tender entheses. Small peripheral joints were predominantly affected. US found inflammation in ≥1 joint or enthesis in 52 [49.5 %] patients; 29 [27.4 %] had US synovitis in ≥1 joint, while 36 [34%] had US enthesitis. Fibromyalgia classification criteria were fulfilled in seven [7.9%] patients. There was no difference in clinical or US findings between patients with UC and CD, nor between patients with active and inactive IBD. CONCLUSION Half of the patients with newly diagnosed IBD had inflammation in their peripheral joints and/or entheses, documented by rheumatological clinical and US evaluations. This indicates a need for multidisciplinary collaboration to ensure an optimal therapeutic strategy for suppressing inflammation in all disease domains.
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Affiliation(s)
- Nora Vladimirova
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mohamed Attauabi
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Gorm Madsen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Viktoria Fana
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Charlotte Wiell
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Uffe Møller Døhn
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Flemming Bendtsen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Seidelin
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Johan Burisch
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Jassel OK, Tahir H, Bamford S, Giuffrida P. A Survey Exploring Inflammatory Back Pain in Patients With Inflammatory Bowel Disease. Cureus 2024; 16:e55264. [PMID: 38558651 PMCID: PMC10981531 DOI: 10.7759/cureus.55264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Diagnostic delay of axial spondyloarthritis (axSpA) is a widely recognized issue worldwide, providing a great burden for patients with this disease. AxSpA is present in a significant proportion of patients with inflammatory bowel disease (IBD). This UK study primarily aims to identify the presence of inflammatory back pain (IBP) in patients attending IBD clinic. Further aims of this study include investigating if participants had received further referrals and diagnoses for their IBP and considering factors contributing to diagnostic delay. Methods Patients were recruited from a Royal Free London NHS Trust hospital's IBD clinic. Each participant completed a 23-question survey. The Berlin criteria were applied to the questions to investigate the presence of IBP. Further questions were asked about their IBD diagnosis and treatment, the healthcare professionals they had seen for their back pain, and other extra-articular features associated with axSpA. Results Seventy-five patients completed the online survey sent out via email. Forty percent (n = 30) of participants were female and 60% (n = 45) were male. Sixty-one percent (n = 36) of participants from the colitis clinic reported they had back pain, and 41% of the participants reported back pain for over three months. Of these, 39% (12) of participants fulfilled the Berlin criteria for IBP. Of patients experiencing back pain for over three months, we found that 10% (3) fulfilled the Berlin criteria but had not received a diagnosis for their IBP. All patients who had fulfilled the Berlin criteria but had not received a diagnosis for their IBP had seen their general practitioner (GP) and an allied healthcare professional, but not a rheumatologist. Conclusions This study highlights the presence of possibly undiagnosed axSpA in patients with IBD. The reasons for the diagnostic delay of axSpA are multifactorial. We consider specific patient characteristics, lack of awareness and education of the condition, and issues in the referral process. There is a need to improve education and awareness of axSpA, reconsider referral processes, and consider new initiatives such as joint specialty clinics to identify and treat axSpA on time.
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Affiliation(s)
| | - Hasan Tahir
- Medicine, University College London, London, GBR
| | - Sian Bamford
- Physiotherapy, Royal Free London NHS Foundation Trust, London, GBR
| | - Paolo Giuffrida
- Gastroenterology, Royal Free London NHS Foundation Trust, London, GBR
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Carubbi F, Alunno A, Viscido A, Baraliakos X, Mariani FM, Di Ruscio E, Altieri P, Ferri C. SpA plus IBD or IBD plus SpA: Does commutative property apply? Autoimmun Rev 2023; 22:103443. [PMID: 37678619 DOI: 10.1016/j.autrev.2023.103443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/03/2023] [Indexed: 09/09/2023]
Abstract
The term spondyloarthritis (SpA) encompasses a group of interrelated disorders characterised by the involvement of the musculoskeletal system as well as extra-articular manifestations like acute anterior uveitis, psoriasis and inflammatory bowel diseases (IBD). Likewise, IBD may present with various extra-intestinal manifestations among which those involving the musculoskeletal system, namely peripheral and axial SpA are the most common. The identification of patients with both SpA and IBD is of paramount importance in clinical practice since the coexistence of these two entities has been associated with great disability and decreased quality of life. In order to achieve an early diagnosis of IBD-SpA it is instrumental that rheumatologists seek for gastrointestinal symptoms in SpA patients and likewise that gastroenterologists seek for inflammatory musculoskeletal symptoms in patients with IBD. This narrative review aims at critically appraising the available evidence about SpA occurring in IBD patients versus IBD occurring in patients with SpA and at highlighting similarities and differences between the two scenarios.
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Affiliation(s)
- Francesco Carubbi
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy.
| | - Alessia Alunno
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Angelo Viscido
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | | | - Francesco Maria Mariani
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Evy Di Ruscio
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Piera Altieri
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Claudio Ferri
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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Keskin O, Farisogullari B, Yardimci GK, Gurbuz B, Kole M, Parlak E, Karadag O, Kav T, Kalyoncu U. The DETAIL questionnaire is a useful and effective tool to assess spondyloarthritis in patients with inflammatory bowel disease. Front Med (Lausanne) 2023; 10:1115362. [PMID: 36844210 PMCID: PMC9947339 DOI: 10.3389/fmed.2023.1115362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction This study aimed to determine the effectiveness of adding a simple questionnaire related to musculoskeletal system to routine outpatient examination to detect undiagnosed axial and peripheral arthropathy in patients with inflammatory bowel disease (IBD). Materials and methods A musculoskeletal symptom questionnaire was given to all patients with IBD during their follow-up examinations between January 2020 and November 2021. The DETAIL questionnaire consisting of six questions about the musculoskeletal system was administered by asking the patients with IBD. All patients who answered yes to at least one of these questions were directed to specialists in the rheumatology department to undergo a detailed examination. The patients who were diagnosed with rheumatological disease after further investigation were recorded. Patients with a known diagnosis of rheumatological disease were excluded from the study. Findings There were 333 patients with IBD included in the study. Of these patients, 41 (12.3%) had a previously diagnosed rheumatological disease and were excluded from the evaluation. Of the remaining 292 patients (147 with ulcerative colitis, 139 with Crohn's disease and six with indeterminate colitis; mean age 42 years), 67 (23%) answered yes to at least one of the questions and were referred to a rheumatology consultation. Rheumatological examination was completed in 52 patients. As a result of the evaluations, 24 patients (8.2%) were diagnosed with enteropathic arthritis (14 axial, 9 peripheral, and 1 axial plus peripheral). Patients with newly diagnosed enteropathy had a lower median disease age than patients without enteropathy. Conclusion The DETAIL questionnaire is an effective and easy tool for identifying missed cases of SpA in patients with IBD.
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Affiliation(s)
- Onur Keskin
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye,*Correspondence: Onur Keskin,
| | - Bayram Farisogullari
- Department of Rheumatology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Gozde Kubra Yardimci
- Department of Rheumatology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Burcu Gurbuz
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Melike Kole
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Erkan Parlak
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Omer Karadag
- Department of Rheumatology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Taylan Kav
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Umut Kalyoncu
- Department of Rheumatology, Hacettepe University School of Medicine, Ankara, Türkiye
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Attauabi M, Madsen GR, Bendtsen F, Wewer AV, Wilkens R, Ilvemark J, Vladimirova N, Jensen AB, Jensen FK, Hansen SB, Siebner HR, Nielsen YJW, Møller JM, Thomsen HS, Thomsen SF, Ingels HAS, Theede K, Boysen T, Bjerrum JT, Jakobsen C, Dorn-Rasmussen M, Jansson S, Yao Y, Burian EA, Møller FT, Fana V, Wiell C, Terslev L, Østergaard M, Bertl K, Stavropoulos A, Seidelin JB, Burisch J. Influence of Genetics, Immunity and the Microbiome on the Prognosis of Inflammatory Bowel Disease (IBD Prognosis Study): the protocol for a Copenhagen IBD Inception Cohort Study. BMJ Open 2022; 12:e055779. [PMID: 35760545 PMCID: PMC9237907 DOI: 10.1136/bmjopen-2021-055779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Inflammatory bowel diseases (IBD), encompassing Crohn's disease and ulcerative colitis, are chronic, inflammatory diseases of the gastrointestinal tract. We have initiated a Danish population-based inception cohort study aiming to investigate the underlying mechanisms for the heterogeneous course of IBD, including need for, and response to, treatment. METHODS AND ANALYSIS IBD Prognosis Study is a prospective, population-based inception cohort study of unselected, newly diagnosed adult, adolescent and paediatric patients with IBD within the uptake area of Hvidovre University Hospital and Herlev University Hospital, Denmark, which covers approximately 1 050 000 inhabitants (~20% of the Danish population). The diagnosis of IBD will be according to the Porto diagnostic criteria in paediatric and adolescent patients or the Copenhagen diagnostic criteria in adult patients. All patients will be followed prospectively with regular clinical examinations including ileocolonoscopies, MRI of the small intestine, validated patient-reported measures and objective examinations with intestinal ultrasound. In addition, intestinal biopsies from ileocolonoscopies, stool, rectal swabs, saliva samples, swabs of the oral cavity and blood samples will be collected systematically for the analysis of biomarkers, microbiome and genetic profiles. Environmental factors and quality of life will be assessed using questionnaires and, when available, automatic registration of purchase data. The occurrence and course of extraintestinal manifestations will be evaluated by rheumatologists, dermatologists and dentists, and assessed by MR cholangiopancreatography, MR of the spine and sacroiliac joints, ultrasonography of peripheral joints and entheses, clinical oral examination, as well as panoramic radiograph of the jaws. Fibroscans and dual-energy X-ray absorptiometry scans will be performed to monitor occurrence and course of chronic liver diseases, osteopenia and osteoporosis. ETHICS AND DISSEMINATION This study has been approved by Ethics Committee of the Capital Region of Denmark (approval number: H-20065831). Study results will be disseminated through publication in international scientific journals and presentation at (inter)national conferences.
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Affiliation(s)
- Mohamed Attauabi
- Department of Gastroenterology and Hepatology, Herlev Hospital, Herlev, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark
| | - Gorm Roager Madsen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark
- Gastrounit, Medical Section, Hvidovre Hospital, Hvidovre, Denmark
| | - Flemming Bendtsen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark
- Gastrounit, Medical Section, Hvidovre Hospital, Hvidovre, Denmark
| | - Anne Vibeke Wewer
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark
- The Paediatric Department, Hvidovre Hospital, Hvidovre, Denmark
| | - Rune Wilkens
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark
- Gastrounit, Medical Section, Hvidovre Hospital, Hvidovre, Denmark
| | - Johan Ilvemark
- Department of Gastroenterology and Hepatology, Herlev Hospital, Herlev, Denmark
| | - Nora Vladimirova
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Annette Bøjer Jensen
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark
| | - Frank Krieger Jensen
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark
| | - Sanja Bay Hansen
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark
- Department of Neurology, Bispebjerg Hospital, Kobenhavn, Denmark
| | | | - Jakob M Møller
- Department of Radiology, Herlev Hospital, Herlev, Denmark
| | | | | | | | - Klaus Theede
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark
- Gastrounit, Medical Section, Hvidovre Hospital, Hvidovre, Denmark
| | - Trine Boysen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark
- Gastrounit, Medical Section, Hvidovre Hospital, Hvidovre, Denmark
| | - Jacob T Bjerrum
- Department of Gastroenterology and Hepatology, Herlev Hospital, Herlev, Denmark
| | - Christian Jakobsen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark
- The Paediatric Department, Hvidovre Hospital, Hvidovre, Denmark
| | - Maria Dorn-Rasmussen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark
- The Paediatric Department, Hvidovre Hospital, Hvidovre, Denmark
| | - Sabine Jansson
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark
- The Paediatric Department, Hvidovre Hospital, Hvidovre, Denmark
| | - Yiqiu Yao
- Department of Dermatology, Bispebjerg Hospital, Kobenhavn, Denmark
| | - Ewa Anna Burian
- Department of Dermatology, Bispebjerg Hospital, Kobenhavn, Denmark
| | - Frederik Trier Møller
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Kobenhavn, Denmark
| | - Viktoria Fana
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Charlotte Wiell
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Kristina Bertl
- Department of Periodontology, Malmö Universitet, Malmo, Sweden
| | - Andreas Stavropoulos
- Malmo Universitet, Malmo, Sweden
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Jakob B Seidelin
- Department of Gastroenterology and Hepatology, Herlev Hospital, Herlev, Denmark
| | - Johan Burisch
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark
- Gastrounit, Medical Section, Hvidovre Hospital, Hvidovre, Denmark
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Rawal KK, Shukla VP, Chikani S, Thakkar M, Ruparelia M, Chudasama RK. Prevalence of extraintestinal manifestations in ulcerative colitis and associated risk factors. Indian J Gastroenterol 2021; 40:477-482. [PMID: 34569013 DOI: 10.1007/s12664-021-01181-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 04/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The data on prevalence of extraintestinal manifestations (EIM) in ulcerative colitis (UC) are scanty and highly variable. METHODS Consecutive patients with UC were prospectively evaluated from November 2016 to August 2017. A detailed history was obtained and physical examination was done. Presence of EIM was confirmed by a consultant rheumatologist, ophthalmologist and dermatologist. Tests performed were hemogram, liver function test, abdominal ultrasound, slit lamp examination, X-ray and magnetic resonance imaging when deemed necessary. RESULTS A total of 227 patients with UC were enrolled in this study. The prevalence of EIM was 7.92%. Mucocutaneous (4.84%) manifestations were the commonest, followed by musculoskeletal (1.32%) and ocular (0.88%). Hepatobiliary (0.44%) and vascular (0.44) manifestations were present in equal frequency. History of appendicectomy was associated with EIM. CONCLUSION The prevalence of EIM in UC was low in our study. History of appendicectomy was a risk factor for EIM.
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Affiliation(s)
- Krishn Kant Rawal
- Prime Institute of Digestive Sciences, Panchvati Main Road, Rajkot, 360 004, India.
| | - Varun P Shukla
- Prime Institute of Digestive Sciences, Panchvati Main Road, Rajkot, 360 004, India
| | - Shabbir Chikani
- Milestone Hospital, Vidyanagar Main Road, Rajkot, 360 002, India
| | - Milan Thakkar
- Retina Care Centre, Virani Chowk, Vidyanagar Main Road, Rajkot, 360 002, India
| | - Mukesh Ruparelia
- Devarsh, 13-Manhar Plot, Mangala Main Road, Rajkot, 360 002, India
| | - Rajesh K Chudasama
- Department of Community Medicine, PDU Government Medical College, Rajkot, 360 001, India
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Variola A, Zanolin ME, Cipriano G, Macchioni P, Martinis F, Pasetti A, Grassi M, Geccherle A, Marchetta A, McGonagle D, Tinazzi I. The IBIS-Q [IBd Identification of Spondyloarthritis Questionnaire]: A Novel Tool to Detect Both Axial and Peripheral Arthritis in Inflammatory Bowel Disease Patients. J Crohns Colitis 2020; 14:1680-1686. [PMID: 32413102 DOI: 10.1093/ecco-jcc/jjaa096] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Both peripheral and axial spondyloarthritis [SpA] occur in inflammatory bowel disease [IBD] and represent the commonest extra-intestinal manifestation. We aimed to develop an easy and quick questionnaire through psychometric analysis, to identify peripheral and axial SpA in IBD patients within an integrated combined multidisciplinary rheumatological-gastroenterology clinic. METHODS Initially, SpA-IBD experts generated a 42-item list covering SpA manifestations including spinal, articular, and entheseal involvement. The new questionnaire was administered before routine clinical IBD assessment. On the same day, rheumatological assessment, blinded to both history and questionnaire results, was performed to explore the presence of the Assessment of SpondyloArthritis International Society [ASAS] criteria for SpA, diagnostic criteria for fibromyalgia [FM], and non-specific low back pain [NSLB]. Factorial analysis of questionnaire items to identify the main factors-receiver operating characteristic [ROC] curves for sensitivity/specificity and Youden index for cut-off-were performed. RESULTS Of the 181 consecutive patients, 56 met the ASAS SpA criteria [prevalence of 30%] with 10 new cases detected [5.5%: seven peripheral and three axial]. Through the psychometric and factorial analysis, we selected 14 items for the final questionnaire [named IBIS-Q]. The IBIS-Q was quick and performed well for detection of axial SpA and peripheral SpA (area under the curve [AUC] 0.88 with 95% confidence interval [CI] 0.830.93). A cut-off of three positive questions had a sensitivity 93% and specificity 77% for SpA patient identification. CONCLUSIONS The IBIS-Q is a useful and simple tool to use in IBD clinics for SpA detection, with a good statistical performance. Further studies are needed to validate it.
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Affiliation(s)
| | - Maria Elisabetta Zanolin
- Department of Diagnostics and Public Health, Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Giovanni Cipriano
- Clinical Research Unit, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | | | - Federica Martinis
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Annalisa Pasetti
- Unit of Gastroenterology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Mario Grassi
- Medical and Genomic Statistics Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | - Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust & University of Leeds, Leeds, UK
| | - Ilaria Tinazzi
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
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8
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Benfaremo D, Luchetti MM, Di Carlo M, Laganà B, Picchianti-Diamanti A, Carubbi F, Pica R, Chimenti MS, Lorenzetti R, Scolieri P, Bruzzese V, Benedetti A, Ramonda R, Giacomelli R, Salaffi F, Gabrielli A. Multicenter Validation of the DETAIL Questionnaire for the Screening of Spondyloarthritis in Patients With Inflammatory Bowel Diseases. J Rheumatol 2020; 48:179-187. [PMID: 32669448 DOI: 10.3899/jrheum.200364] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Spondyloarthritis (SpA) is among the most frequent extraintestinal manifestations of inflammatory bowel diseases (IBD). In this study, we aimed to validate the DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire in a multicenter cohort of patients with IBD enrolled at 11 gastroenterology units. METHODS From October 2018 to March 2019, consecutive adult patients with IBD, either Crohn disease or ulcerative colitis, independently filled out the DETAIL questionnaire in the outpatient waiting room. Within 2 weeks a blinded rheumatologist assessed all the patients, irrespective of the DETAIL results, and classified them to be affected or not by SpA. The performance of the questions was evaluated through Bayesian analysis. RESULTS Overall, 418 patients with IBD filled out the DETAIL questionnaire. Upon rheumatological evaluation, 102 (24.4%) patients received a diagnosis of SpA. Of the 6 questions, the best performances were found in question 6 [positive likelihood ratio (LR)+ 3.77], reporting inflammatory back pain at night, and in question 3 (LR+ 3.31), exploring Achilles enthesitis. The presence of back pain lasting > 3 months (LR+ 2.91), back pain with inflammatory features (LR+ 2.55), and a history of dactylitis (LR+ 2.55), also showed a fairly good performance, whereas a history of peripheral synovitis was slightly worse (LR+ 2.16). The combination of at least 3 questions answered affirmatively yielded a posttest probability of SpA of 80% or more. The presence of alternative diagnoses, such as osteoarthritis or fibromyalgia, represented a minor confounder. CONCLUSION The DETAIL questionnaire is a useful tool for the early detection of SpA in IBD.
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Affiliation(s)
- Devis Benfaremo
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Michele Maria Luchetti
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Marco Di Carlo
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Bruno Laganà
- B. Laganà, MD, A. Picchianti-Diamanti, MD, PhD, Department of Clinical and Molecular Medicine, S. Andrea University Hospital, "Sapienza" University, Rome
| | - Andrea Picchianti-Diamanti
- B. Laganà, MD, A. Picchianti-Diamanti, MD, PhD, Department of Clinical and Molecular Medicine, S. Andrea University Hospital, "Sapienza" University, Rome
| | - Francesco Carubbi
- F. Carubbi, MD, PhD, R. Giacomelli, MD, PhD, Rheumatology Unit, University Hospital "S. Salvatore", Department of Clinical and Biotechnologic Sciences, University of L'Aquila
| | - Roberta Pica
- R. Pica, MD, UOS Gastroenterologia Territoriale, ASL Roma 2, Rome
| | - Maria Sole Chimenti
- M.S. Chimenti, MD, UOC Reumatologia, Dipartimento di Medicina dei Sistemi, Università di Tor Vergata, Roma
| | - Roberto Lorenzetti
- R. Lorenzetti, MD, UOC Gastroenterologia, Polo Ospedaliero Nuovo Regina Margherita - S.Spirito, Rome
| | - Palma Scolieri
- P. Scolieri, MD, V. Bruzzese, MD, UOC Medicina Interna e Reumatologia, Polo Ospedaliero Nuovo Regina Margherita - S.Spirito, Rome
| | - Vincenzo Bruzzese
- P. Scolieri, MD, V. Bruzzese, MD, UOC Medicina Interna e Reumatologia, Polo Ospedaliero Nuovo Regina Margherita - S.Spirito, Rome
| | - Antonio Benedetti
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Roberta Ramonda
- R. Ramonda, MD, PhD, UOC di Reumatologia, Dipartimento di Medicina DIMED, Università di Padova, Italy
| | - Roberto Giacomelli
- F. Carubbi, MD, PhD, R. Giacomelli, MD, PhD, Rheumatology Unit, University Hospital "S. Salvatore", Department of Clinical and Biotechnologic Sciences, University of L'Aquila
| | - Fausto Salaffi
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Armando Gabrielli
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
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9
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Ribaldone DG, Vernero M, Parisi S, Ditto MC, Pellicano R, Morino M, Saracco GM, Fusaro E, Astegiano M. Risk factors of suspected spondyloarthritis among inflammatory bowel disease patients. Scand J Gastroenterol 2019; 54:1233-1236. [PMID: 31549896 DOI: 10.1080/00365521.2019.1668052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Occurring in approximately 20-30% of patients, spondyloarthritis is the most common extraintestinal manifestation in inflammatory bowel disease (IBD).Aims: To look for risk factors of spondyloarthritis among inflammatory bowel disease patients.Methods: We modified the STRIPP questionnaire created for psoriatic patients and we created a rapid questionnaire for rheumatologic investigation in IBD patients (STRII). We submitted the questionnaire to all consecutive patients with a known spondyloarthritis in our centre and to patients with a negative rheumatological diagnosis to find the cut-off value. Finally, we prospectively submitted the STRII questionnaire to all consecutive IBD patients in our centre.Results: A cut-off ≥3 correlated with spondyloarthritis with an AUC = 0.91. The STRII questionnaire was submitted to 1147 IBD patients. Two hundred and forty-four out of 1147 (21.3%) collected a STRII score of ≥3. Female sex (p < .0001) and Crohn's disease (p = .023) were risk factors. Patients with a history of at least 1 immunosuppressant or biologic drug (p = .002 and p < .0001, respectively) had a higher rate of positivity to STRII questionnaire.Conclusion: Among IBD patients, females, Crohn's disease, those with a history of at least 1 immunosuppressive or biological therapy are at increased risk of spondyloarthritis.
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Affiliation(s)
| | - Marta Vernero
- First Department of Internal Medicine, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Simone Parisi
- S.C. Reumatologia, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Maria Chiara Ditto
- S.C. Reumatologia, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | | | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Enrico Fusaro
- S.C. Reumatologia, Città Della Salute e Della Scienza di Torino, Turin, Italy
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10
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Luchetti MM, Benfaremo D, Bendia E, Bolognini L, Fava G, Marini F, Di Sario A, Ciferri M, Di Nicola F, Marconi V, Perini L, Manfredi L, Pomponio G, Mosca P, Benedetti A, Gabrielli A. Clinical and patient reported outcomes of the multidisciplinary management in patients with inflammatory bowel disease-associated spondyloarthritis. Eur J Intern Med 2019; 64:76-84. [PMID: 31047747 DOI: 10.1016/j.ejim.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Arthritis is the most frequent extra-intestinal manifestation in patients with inflammatory bowel diseases (IBD). The coexistence of intestinal and articular inflammation advocates the need for a multidisciplinary management of patients with IBD-associated spondyloarthritis. METHODS Consecutive IBD patients were evaluated jointly by the gastroenterologist and the rheumatologist in a combined clinic. All the patients were assessed and screened for articular involvement, disease activity and health related quality of life. After the prescription of a shared treatment, patients with spondyloarthritis were followed up for 24 months. RESULTS Two hundred sixty-two IBD patients, including 80 who were classified as affected by spondyloarthritis according to the ASAS criteria, were included in the study. At baseline, patients with both IBD and spondyloarthritis showed worse quality of life in both the physical and mental domains. The multidisciplinary management provided a significant improvement of gastrointestinal and articular manifestations, as well as the health-related quality of life. Moreover, global and gastrointestinal-specific quality of life significantly correlated with articular disease activity. CONCLUSION The multidisciplinary management significantly improves both articular and gastrointestinal disease activities and the quality of life of patients with IBD-associated spondyloarthritis. An appropriate screening strategy and the integrated management of these patients should be encouraged and employed in clinical practice.
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Affiliation(s)
- Michele Maria Luchetti
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy.
| | - Devis Benfaremo
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Emanuele Bendia
- Clinica di Gastroenterologia, Università Politecnica delle Marche, 60020 Ancona, Italy; IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Laura Bolognini
- IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Giammarco Fava
- IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Francesco Marini
- IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Antonio Di Sario
- Clinica di Gastroenterologia, Università Politecnica delle Marche, 60020 Ancona, Italy; IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Monia Ciferri
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Francesca Di Nicola
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Valentina Marconi
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Lucia Perini
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Lucia Manfredi
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Giovanni Pomponio
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Piergiorgio Mosca
- IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Antonio Benedetti
- Clinica di Gastroenterologia, Università Politecnica delle Marche, 60020 Ancona, Italy; IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Armando Gabrielli
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
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11
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Sanz Sanz J, Juanola Roura X, Seoane-Mato D, Montoro M, Gomollón F. Criterios de cribado de enfermedad inflamatoria intestinal y espondiloartritis para derivación de pacientes entre Reumatología y Gastroenterología. ACTA ACUST UNITED AC 2018; 14:68-74. [DOI: 10.1016/j.reuma.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 02/07/2023]
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12
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Sanz Sanz J, Juanola Roura X, Seoane-Mato D, Montoro M, Gomollón F. Criterios de cribado de enfermedad inflamatoria intestinal y espondiloartritis para derivación de pacientes entre Reumatología y Gastroenterología. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 41:54-62. [DOI: 10.1016/j.gastrohep.2017.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/03/2017] [Indexed: 01/12/2023]
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13
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The DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire: development and preliminary testing of a new tool to screen patients with inflammatory bowel disease for the presence of spondyloarthritis. Clin Rheumatol 2017; 37:1037-1044. [DOI: 10.1007/s10067-017-3937-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/07/2017] [Accepted: 11/27/2017] [Indexed: 12/13/2022]
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14
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Kehl AS, Learch TJ, Li D, McGovern DPB, Weisman MH. Relationship between the gut and the spine: a pilot study of first-degree relatives of patients with ankylosing spondylitis. RMD Open 2017; 3:e000437. [PMID: 28879050 PMCID: PMC5574426 DOI: 10.1136/rmdopen-2017-000437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/26/2017] [Accepted: 05/28/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Amy S Kehl
- Department of Rheumatology, University of California Los Angeles, Los Angeles, California, USA
| | - Thomas J Learch
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dalin Li
- F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dermot P B McGovern
- F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael H Weisman
- Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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15
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Armstrong SM, Wither JE, Borowoy AM, Landolt-Marticorena C, Davis AM, Johnson SR. Development, Sensibility, and Validity of a Systemic Autoimmune Rheumatic Disease Case Ascertainment Tool. J Rheumatol 2016; 44:18-23. [PMID: 27803141 DOI: 10.3899/jrheum.160327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Case ascertainment through self-report is a convenient but often inaccurate method to collect information. The purposes of this study were to develop, assess the sensibility, and validate a tool to identify cases of systemic autoimmune rheumatic diseases (SARD) in the outpatient setting. METHODS The SARD tool was administered to subjects sampled from specialty clinics. Determinants of sensibility - comprehensibility, feasibility, validity, and acceptability - were evaluated using a numeric rating scale from 1-7. Comprehensibility was evaluated using the Flesch Reading Ease and the Flesch-Kincaid Grade Level. Self-reported diagnoses were validated against medical records using Cohen's κ statistic. RESULTS There were 141 participants [systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis, Sjögren syndrome (SS), inflammatory myositis (polymyositis/dermatomyositis; PM/DM), and controls] who completed the questionnaire. The Flesch Reading Ease score was 77.1 and the Flesch-Kincaid Grade Level was 4.4. Respondents endorsed (mean ± SD) comprehensibility (6.12 ± 0.92), feasibility (5.94 ± 0.81), validity (5.35 ± 1.10), and acceptability (3.10 ± 2.03). The SARD tool had a sensitivity of 0.91 (95% CI 0.88-0.94) and a specificity of 0.99 (95% CI 0.96-1.00). The agreement between the SARD tool and medical record was κ = 0.82 (95% CI 0.77-0.88). Subgroup analysis by SARD found κ coefficients for SLE to be κ = 0.88 (95% CI 0.79-0.97), SSc κ = 1.0 (95% CI 1.0-1.0), PM/DM κ = 0.72 (95% CI 0.49-0.95), and SS κ = 0.85 (95% CI 0.71-0.99). The screening questions had sensitivity ranging from 0.96 to 1.0 and specificity ranging from 0.88 to 1.0. CONCLUSION This SARD case ascertainment tool has demonstrable sensibility and validity. The use of both screening and confirmatory questions confers added accuracy.
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Affiliation(s)
- Susan M Armstrong
- From the Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals; Division of Genetics and Development, and Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network; Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,S.M. Armstrong, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, University of Toronto; J.E. Wither, MD, PhD, Senior Scientist, Division of Genetics and Development, Toronto Western Research Institute, University Health Network, and Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network, and University of Toronto; A.M. Borowoy, MD, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, and University of Toronto; C. Landolt-Marticorena, MD, PhD, Toronto Western Research Institute, University Health Network; A.M. Davis, PhD, Senior Scientist, Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, and Institute of Health Policy, Management and Evaluation, University of Toronto; S.R. Johnson, MD, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, and Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Joan E Wither
- From the Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals; Division of Genetics and Development, and Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network; Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,S.M. Armstrong, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, University of Toronto; J.E. Wither, MD, PhD, Senior Scientist, Division of Genetics and Development, Toronto Western Research Institute, University Health Network, and Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network, and University of Toronto; A.M. Borowoy, MD, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, and University of Toronto; C. Landolt-Marticorena, MD, PhD, Toronto Western Research Institute, University Health Network; A.M. Davis, PhD, Senior Scientist, Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, and Institute of Health Policy, Management and Evaluation, University of Toronto; S.R. Johnson, MD, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, and Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Alan M Borowoy
- From the Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals; Division of Genetics and Development, and Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network; Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,S.M. Armstrong, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, University of Toronto; J.E. Wither, MD, PhD, Senior Scientist, Division of Genetics and Development, Toronto Western Research Institute, University Health Network, and Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network, and University of Toronto; A.M. Borowoy, MD, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, and University of Toronto; C. Landolt-Marticorena, MD, PhD, Toronto Western Research Institute, University Health Network; A.M. Davis, PhD, Senior Scientist, Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, and Institute of Health Policy, Management and Evaluation, University of Toronto; S.R. Johnson, MD, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, and Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Carolina Landolt-Marticorena
- From the Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals; Division of Genetics and Development, and Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network; Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,S.M. Armstrong, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, University of Toronto; J.E. Wither, MD, PhD, Senior Scientist, Division of Genetics and Development, Toronto Western Research Institute, University Health Network, and Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network, and University of Toronto; A.M. Borowoy, MD, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, and University of Toronto; C. Landolt-Marticorena, MD, PhD, Toronto Western Research Institute, University Health Network; A.M. Davis, PhD, Senior Scientist, Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, and Institute of Health Policy, Management and Evaluation, University of Toronto; S.R. Johnson, MD, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, and Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Aileen M Davis
- From the Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals; Division of Genetics and Development, and Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network; Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,S.M. Armstrong, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, University of Toronto; J.E. Wither, MD, PhD, Senior Scientist, Division of Genetics and Development, Toronto Western Research Institute, University Health Network, and Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network, and University of Toronto; A.M. Borowoy, MD, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, and University of Toronto; C. Landolt-Marticorena, MD, PhD, Toronto Western Research Institute, University Health Network; A.M. Davis, PhD, Senior Scientist, Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, and Institute of Health Policy, Management and Evaluation, University of Toronto; S.R. Johnson, MD, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, and Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Sindhu R Johnson
- From the Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals; Division of Genetics and Development, and Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network; Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,S.M. Armstrong, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, University of Toronto; J.E. Wither, MD, PhD, Senior Scientist, Division of Genetics and Development, Toronto Western Research Institute, University Health Network, and Arthritis Centre of Excellence, Division of Rheumatology, Departments of Medicine and Immunology, University Health Network, and University of Toronto; A.M. Borowoy, MD, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, and University of Toronto; C. Landolt-Marticorena, MD, PhD, Toronto Western Research Institute, University Health Network; A.M. Davis, PhD, Senior Scientist, Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, and Institute of Health Policy, Management and Evaluation, University of Toronto; S.R. Johnson, MD, PhD, Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western and Mount Sinai Hospitals, and Institute of Health Policy, Management and Evaluation, University of Toronto.
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16
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Rheumatic manifestations in inflammatory bowel diseases: a link between GI and rheumatology. Clin Rheumatol 2015; 35:291-6. [DOI: 10.1007/s10067-015-3116-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 11/08/2015] [Indexed: 12/18/2022]
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17
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Kamo K, Shuto T, Haraguchi A. Prevalence of spondyloarthritis symptom in inflammatory bowel disease patients: A questionnaire survey. Mod Rheumatol 2014; 25:435-7. [DOI: 10.3109/14397595.2014.964925] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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18
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Wallis D, Inman RD. Recognition of Preclinical and Early Disease in Axial Spondyloarthritis. Rheum Dis Clin North Am 2014; 40:685-97. [DOI: 10.1016/j.rdc.2014.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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