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Falloon K, Dossaji Z, Mude P, Abushamma S, Ananthakrishnan A, Barnes EL, Bhalla J, Bhattacharya A, Cheemalavagu S, Colombel JF, Cross RK, Ermann J, Ha C, Herfarth H, Horst S, Hou J, Husni ME, Kline TM, Kuhn KA, Long MD, Loftus EV, Lukin DJ, Patel A, Rubin DT, Scherl EJ, Shah SA, Siaton BC, Sleiman J, Qazi T, Weisman MH, Cohen BL, Feagan BG, Rieder F. Diagnosis of Inflammatory Bowel Disease-Associated Peripheral Arthritis: A Systematic Review. Inflamm Bowel Dis 2024:izae114. [PMID: 38836521 DOI: 10.1093/ibd/izae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Inflammatory bowel disease (IBD)-associated peripheral spondyloarthritis (pSpA) decreases quality of life and remains poorly understood. Given the prevalence of this condition and its negative impact, it is surprising that evidence-based disease definitions and diagnostic strategies are lacking. This systematic review summarizes available data to facilitate development and validation of diagnostics, patient-reported outcomes, and imaging indices specific to this condition. METHODS A literature search was conducted. Consensus or classification criteria, case series, cross-sectional studies, cohort studies, and randomized controlled trials related to diagnosis were included. RESULTS A total of 44 studies reporting data on approximately 1500 patients with pSpA were eligible for analysis. Data quality across studies was only graded as fair to good. Due to large heterogeneity, meta-analysis was not possible. The majority of studies incorporated patient-reported outcomes and a physical examination. A total of 13 studies proposed or validated screening tools, consensus, classification, or consensus criteria. A total of 28 studies assessed the role of laboratory tests, none of which were considered sufficiently accurate for use in diagnosis. A total of 17 studies assessed the role of imaging, with the available literature insufficient to fully endorse any imaging modality as a robust diagnostic tool. CONCLUSIONS This review highlights existing inconsistency and lack of a clear diagnostic approach for IBD-associated pSpA. Given the absence of an evidence-based approach, a combination of existing criteria and physician assessment should be utilized. To address this issue comprehensively, our future efforts will be directed toward pursuit of a multidisciplinary approach aimed at standardizing evaluation and diagnosis of IBD-associated pSpA.
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Affiliation(s)
- Katherine Falloon
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Zahra Dossaji
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Pooja Mude
- Department of Gastroenterology, Ascension Providence, Southfield, MI, USA
| | - Suha Abushamma
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | | | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Jaideep Bhalla
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Shashank Cheemalavagu
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joerg Ermann
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christina Ha
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Hans Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Sara Horst
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason Hou
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - M Elaine Husni
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Theresa M Kline
- Cleveland Clinic Foundation, Cleveland Clinic Library, Cleveland, OH, USA
| | - Kristine A Kuhn
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Dana J Lukin
- Department of Gastroenterology and Hepatology, Weill Cornell Medical Center, NY, NY, USA
| | - Aditi Patel
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David T Rubin
- Department of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Ellen J Scherl
- Department of Gastroenterology and Hepatology, Weill Cornell Medical Center, NY, NY, USA
| | - Samir A Shah
- Department of Gastroenterology, Brown University, Providence, RI, USA
| | - Bernadette C Siaton
- Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph Sleiman
- Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Taha Qazi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Michael H Weisman
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Brian G Feagan
- Division of Gastroenterology, Department of Medicine, Western University, London, ON, Canada
- Alimentiv Inc., London, ON, Canada
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
- Cleveland Clinic Program for Global Translational Inflammatory Bowel Disease, Cleveland Clinic, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, OH, USA
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Kesarwani V, Sinnappan S, Husni ME, Weisman MH, Ermann J. Screening Tools for Spondyloarthritis in Patients With Psoriasis, Uveitis, and Inflammatory Bowel Disease: A Scoping Review. Arthritis Care Res (Hoboken) 2024; 76:860-870. [PMID: 38303576 PMCID: PMC11132942 DOI: 10.1002/acr.25308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Extramusculoskeletal manifestations of spondyloarthritis (SpA) may precede the development of articular features. Patients seen in ophthalmology, dermatology, and gastroenterology clinics with uveitis, psoriasis, or inflammatory bowel disease (IBD) may have undiagnosed SpA. We set out to identify and evaluate screening tools for SpA in patients with psoriasis, uveitis, and IBD and determine factors that influence the performance of these instruments. METHODS This scoping review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Web of Science were searched from inception to January 2022. RESULTS We identified 13 screening tools for psoriatic arthritis, 2 SpA screening tools for uveitis, and 3 SpA screening tools for IBD. All screening tools were patient-oriented questionnaires except for the Dublin Uveitis Evaluation Tool, a physician-applied algorithm. The questionnaires varied in length, scoring method, cutoff score, and spectrum of included SpA features. Average completion time was less than five minutes. Across the three patient populations, the sensitivities and specificities of these screening tools were comparable in the primary validation cohorts. Sensitivities and specificities were generally lower in secondary validation studies, with marked variability among cohorts. CONCLUSION Our results highlight the heterogeneity and limitations of existing SpA screening tools. Although these tools show promise for use within a specific target population, none are generalizable to all patients with extramusculoskeletal manifestations at risk of SpA. Future studies should explore the utility of a generic patient-oriented SpA screening tool that can be applied to patients with psoriasis, uveitis, or IBD; is easy to use and comprehend; and captures all clinical domains of SpA.
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Affiliation(s)
| | | | | | - Michael H. Weisman
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
| | - Joerg Ermann
- Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
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3
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Conigliaro P, D’Antonio A, Wlderk A, Sabuzi F, Ferraioli M, Sichi L, Da Ros V, Biancone L, Bergamini A, Sole Chimenti M. Clinical and imaging findings in enteropathic spondyloarthritis with special emphasize in diagnostic delay: a cross-sectional study. Ther Adv Chronic Dis 2024; 15:20406223241229843. [PMID: 38380226 PMCID: PMC10878219 DOI: 10.1177/20406223241229843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/10/2024] [Indexed: 02/22/2024] Open
Abstract
Background Enteropathic spondyloarthritides (eSpAs) are chronic inflammatory joint diseases associated with inflammatory bowel disease (IBD). Limited data are available on the prevalence since arthritis in IBD patients may be underestimated because medications may hide disease activity with a possible diagnostic delay. Objectives We aimed to evaluate diagnostic delay in eSpA and explore associated demographic, clinical, and radiographic characteristics. Design Single-centre cross-sectional study conducted on consecutive out-patients referred to the combined Gi-Rhe clinic (November 2018-October 2019). Methods We analysed eSpA patients for diagnostic delay, disease activity, inflammatory markers, conventional radiography (CR) and magnetic resonance images (MRI) of sacroiliac joints/spine. Results A total of 190 eSpA patients [118 peripheral SpA, 72 axial (Ax) SpA including 44 non-radiographic (nr)-axSpA] were enrolled. axSpA patients had a higher prevalence of men sex, HLA-B27 positivity, uveitis and pancolitis compared with peripheral eSpA. Median diagnostic delay in eSpA was 48 months (IQR 6-77) with no difference between axial and peripheral patients. Radiographic-axial SpA (r-axSpA) patients displayed a higher diagnostic delay compared with nr-axSpA (median/IQR 36/17-129 versus 31/10-57 months, p = 0.03) and were older, with longer disease duration, low education status and high rate of employment than patients with nr-axSpA. r-axSpA patients with sclerosis, syndesmophytes and bridge at CR had higher diagnostic delay than those without lesions. Men showed higher prevalence of spine damage lesions than women as sclerosis, squaring, syndesmophytes and bridges. Longer disease duration was detected in patients with radiographic damage as bridge and sacroiliitis grade 3. On MRI, sacroiliac bone oedema was associated with reduced diagnostic delay, whereas bone erosions were associated with higher diagnostic delay compared with that in patients without these lesions. Patients with psoriasis displayed a higher diagnostic delay compared to those without skin involvement. Conclusion Diagnostic delay was higher in r-axSpA compared with nr-axSpA despite the same treatment. Demographic, clinical features and radiological lesions were associated with diagnostic delay.
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Affiliation(s)
- Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Via Montpellier 1, Rome 00133, Italy
| | - Arianna D’Antonio
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Wlderk
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Federico Sabuzi
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Mario Ferraioli
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Sichi
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Valerio Da Ros
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Livia Biancone
- Gastroenterology Unit, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Bergamini
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
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Fatica M, Monosi B, Conigliaro P, D'Antonio A, Essofi S, Cuccagna E, Bergamini A, Biancone L, Monteleone G, Triggianese P, Calabrese E, Chimenti MS. Impact of biological therapy in reducing the risk of arthritis development in inflammatory bowel diseases. RMD Open 2024; 10:e003820. [PMID: 38296800 PMCID: PMC10831466 DOI: 10.1136/rmdopen-2023-003820] [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: 10/18/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE Evaluate spondyloarthritis (SpA) incidence in inflammatory bowel diseases (IBD) between patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) and conventional DMARDs (cDMARDs) and define risk factors associated with SpA development. METHODS Retrospective cohort study was conducted on patients with Crohn's disease (CD) or ulcerative colitis (UC) and divided into two cohorts: cDMARDs or bDMARDs/targeted synthetic (ts) DMARDs treated patients. Rheumatological assessment was performed in patients presenting musculoskeletal symptoms. Multivariate analysis and Kaplan-Meier curves were used to evaluate the adjusted SpA risk development. RESULTS 507 patients were included in the study. 176 patients with CD received bDMARDs, 112 cDMARDs and 106 new SpA diagnosies were formulated. Females (OR 1.7 (95% CI 1.1 to 3), adjusted p=0.04), non-stricturing/non-penetrating phenotype (OR 2 (95% CI 1.1 to 3.4), adjusted p=0.01), psoriasis (OR 2.1 (95% CI 1 to 4.6), adjusted p=0.04) and non-infectious uveitis (OR 6.8 (95% CI 1.4 to 33.4), adjusted p=0.01) were associated with increased SpA risk development, while bDMARDs usage was protective (OR 0.4 (95% CI 0.2 to 0.8), adjusted p=0.01), statistically higher than cDMARDs throughout the entire follow-up (effect size 0.47). 98 patients with UC received b-tsDMARDs, 121 cDMARDs and 56 new SpA diagnoses were formulated. Females (OR 2.1 (95% CI 1 to 4.3), adjusted p=0.02) and psoriasis (OR 2.7 (95% CI 1 to 6.8), adjusted p=0.03) were associated with increased SpA risk development, while bDMARDs were protective for SpA development for up to 12 months of treatment compared with cDMARDs (p=0.03). CONCLUSIONS bDMARDs treatment had an impact in reducing SpA development and clinical associated risk factors to transition from IBD to IBD-SpA emerged.
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Affiliation(s)
- Mauro Fatica
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Benedetta Monosi
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Conigliaro
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Arianna D'Antonio
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sara Essofi
- Gastrointestinal Unit, Departement of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elisa Cuccagna
- Gastrointestinal Unit, Departement of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Bergamini
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Livia Biancone
- Gastrointestinal Unit, Departement of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Monteleone
- Gastrointestinal Unit, Departement of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Triggianese
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emma Calabrese
- Gastrointestinal Unit, Departement of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Maria Sole Chimenti
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Dalal RS, Ermann J, Carlin A, Mitri J, Allegretti JR. Activity of axial spondyloarthritis after one year of anti-tumor necrosis factor therapy among patients with inflammatory bowel diseases. Clin Rheumatol 2023; 42:3001-3006. [PMID: 37428414 DOI: 10.1007/s10067-023-06695-5] [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: 04/14/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
The disease activity of axSpA after initiating anti-TNF agents for inflammatory bowel diseases (IBD) is poorly understood. We sought to examine the disease activity of axial spondyloarthritis (axSpA) after initiation of anti-tumor necrosis factor (TNF) agents among patients with IBD. This retrospective cohort study included adults with IBD and axSpA who initiated anti-TNF agents between 1/1/2012-10/1/2021 at a large academic center. The primary outcome was symptom resolution (SR) of axSpA at 12 months ("0/10 pain" or "no pain" or "controlled pain" with no morning stiffness and no use of daily NSAIDs). The secondary outcome was clinical remission (CR) of IBD at 12 months (simple clinical colitis activity index <3, Harvey-Bradshaw Index <5, or provider assessment with no use of oral/IV steroids for 30 days). Associations between baseline characteristics and SR of axSpA were examined using logistic regression. 82 patients with axSpA and IBD initiated anti-TNF agents. At 12 months, 52% and 74% achieved SR of axSpA and CR of IBD, respectively. IBD duration <5 years (OR 3.0, 95% CI 1.2-7.5) and adalimumab use (reference: all other anti-TNFs; OR 2.7, 95% CI 1.002-7.1) were associated with SR of axSpA at 12 months. 52% of patients with axSpA and IBD achieved SR of axSpA at 12 months after initiating anti-TNF therapy. Shorter disease duration and adalimumab use may be associated with higher odds of SR. Larger studies are needed to confirm these findings, examine additional clinical predictors of SR, and identify more effective therapeutics for this population.
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Affiliation(s)
- Rahul S Dalal
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Joerg Ermann
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Carlin
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Mitri
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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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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Barnett R, Gaffney K, Sengupta R. Diagnostic delay in axial spondylarthritis: A lost battle? Best Pract Res Clin Rheumatol 2023; 37:101870. [PMID: 37658016 DOI: 10.1016/j.berh.2023.101870] [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: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023]
Abstract
Diagnostic delay in axial spondylarthritis (axSpA) remains an unacceptable worldwide problem; with evidence suggesting significant detrimental impact both clinically on the individual, and economically on society. There is therefore, a need for global action across various healthcare professions that come into contact with patients living, and suffering, with undiagnosed axSpA. Recent estimates of the median diagnostic delay suggest that globally, individuals with axSpA wait between 2 and 6 years for a diagnosis - revealing a clear benchmark for improvement. This timespan presents a window of opportunity for earlier diagnosis and intervention, which will likely improve patient outcomes. This review describes the current diagnostic delay as estimated across countries and over time, before presenting evidence from published strategies that may be implemented to improve this delay across primary and secondary care, including for specialties treating extra-musculoskeletal manifestations of axSpA (ophthalmology, gastroenterology, dermatology). Ongoing campaigns tackling delayed diagnosis in axSpA are also highlighted.
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Affiliation(s)
- Rosemarie Barnett
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK; Rheumatology Department, Royal National Hospital for Rheumatic Diseases & Brownsword Therapies Centre, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
| | - Karl Gaffney
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk & Norwich, University Hospital, Colney Lane, Norwich NR4 7UY, UK.
| | - Raj Sengupta
- Rheumatology Department, Royal National Hospital for Rheumatic Diseases & Brownsword Therapies Centre, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
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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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Gomollón F, Seoane-Mato D, Montoro MA, Juanola X, Trujillo-Martin E, Carrillo-Palau M, Matallana V, García-Magallón B, Ber Y, Ramos L, Perez-Pampin E, Ferreiro-Iglesias R, Rodríguez-Alonso L, Marco-Pascual C, Sanz Sanz J. Validation of screening criteria for spondyloarthritis in patients with inflammatory bowel disease in routine clinical practice. Dig Liver Dis 2022; 54:755-762. [PMID: 35039222 DOI: 10.1016/j.dld.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Spondyloarthritis (SpA) is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). Diagnostic delay must be avoided. AIMS We assessed the validity of SpA screening criteria (any of the following characteristics: chronic low back pain with onset before 45 years of age; inflammatory lower back pain or alternating buttock pain; arthritis; heel enthesitis; dacylitis; HLA-B27 positivity; sacroiliitis on imaging). METHODS This was a multicenter cross-sectional observational study in IBD patients aged ≥18 years. After evaluating the SpA screening criteria, the gastroenterologists referred the participants to the rheumatologists, who determined whether the patient fulfilled the screening criteria and carried out the necessary tests for SpA diagnosis. RESULTS 35 (11.7%) out of 300 patients were diagnosed with SpA. The combination with the best balance between sensitivity and specificity (91.4% and 72.1%, respectively, when applied by the rheumatologists; 80% and 78.9%, when applied by the gastroenterologists) for SpA screening, was fulfillment of any of the following: chronic low back pain with onset before age 45 years, inflammatory low back pain or alternating buttock pain, arthritis, or dactylitis. CONCLUSION This is one of the first studies to validate SpA screening criteria in IBD patients in routine clinical practice.
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Affiliation(s)
- Fernando Gomollón
- Medical School, University of Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.
| | | | - Miguel A Montoro
- Unit of Gastroenterology, Hepatology and Nutrition, Hospital General San Jorge, Huesca, Spain
| | - Xavier Juanola
- Department of Rheumatology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elisa Trujillo-Martin
- Department of Rheumatology, Hospital Universitario de Canarias, Sta. Cruz de Tenerife, Spain
| | - Marta Carrillo-Palau
- Department of Gastroenterology, Hospital Universitario de Canarias, Sta. Cruz de Tenerife, Spain
| | - Virginia Matallana
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Yolanda Ber
- Unit of Gastroenterology, Hepatology and Nutrition, Hospital General San Jorge, Huesca, Spain
| | - Laura Ramos
- Department of Gastroenterology, Hospital Universitario de Canarias, Sta. Cruz de Tenerife, Spain
| | - Eva Perez-Pampin
- Department of Rheumatology, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Rocío Ferreiro-Iglesias
- Department of Gastroenterology, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Lorena Rodríguez-Alonso
- Department of Gastroenterology and Hepatology, Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carla Marco-Pascual
- Department of Rheumatology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jesús Sanz Sanz
- Department of Rheumatology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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Ono K, Kishimoto M, Deshpande GA, Fukui S, Kawaai S, Sawada H, Matsuura M, Rodriguez VR, Proft F, Tada K, Tamura N, Taniguchi Y, Hirata A, Kameda H, Tsuji S, Kaneko Y, Dobashi H, Okano T, Haji Y, Morita A, Okada M, Komagata Y, Medina CL, Molto A, Dougados M, Hisamatsu T, Tomita T, Kaname S. Clinical characteristics of patients with spondyloarthritis and inflammatory bowel disease versus inflammatory bowel disease-related arthritis. Rheumatol Int 2022; 42:1751-1766. [DOI: 10.1007/s00296-022-05117-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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11
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Ali A, Schmidt M, Piskin D, Crowley E, Berard R. Epidemiology of Musculoskeletal Manifestations in Pediatric Inflammatory Bowel Disease: A Systematic Review. ACR Open Rheumatol 2022; 4:547-554. [PMID: 35352509 PMCID: PMC9190227 DOI: 10.1002/acr2.11431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Pediatric inflammatory bowel disease (p-IBD) is a chronic relapsing gastrointestinal disorder of childhood with long-term morbidity. Several extraintestinal manifestations are described, the most common being joint pain and/or inflammation. However, patient and disease characteristics, treatments, and outcomes of p-IBD-associated musculoskeletal disease are not well established. Our study aims to summarize the recent literature on the epidemiology of musculoskeletal manifestations in p-IBD in the era of biologics. METHODS A systematic search of PubMed, Embase, Cochrane Library, Web of Science Core Collection, and Cumulative Index to Nursing and Allied Health Literature databases was performed with relevant keywords. Studies in English published from January 1, 2000, to December 21, 2020, were included. In total, 3893 articles were identified and screened. Study and population characteristics and outcomes of interest were recorded. Risk of bias assessment was performed using the Joanna Briggs Institute Critical Appraisal Tools. RESULTS Thirteen studies were included for full review, which were primarily single-center observational studies with retrospective or cross-sectional designs. The diagnostic criteria and definitions used for musculoskeletal manifestations varied. Musculoskeletal manifestation prevalence ranged from 2% to 35%. Only one study assessed the response of musculoskeletal manifestations to biologics. Risk of bias demonstrated heterogeneity in study quality. CONCLUSION This is the first systematic review of musculoskeletal manifestations in p-IBD. Analysis was limited because of variability in study design and data-reporting methods. Definitions varied among included studies, with a clear lack in standardization. Our study demonstrates the need for standardized assessment of musculoskeletal manifestations of p-IBD and further research to explore optimal management to advance care for this group of children.
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Affiliation(s)
- Aaisham Ali
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - David Piskin
- Lawson Health Research Institute, London, Ontario, Canada
| | - Eileen Crowley
- Schulich School of Medicine and Dentistry, Western University, Children's Hospital of Western Ontario, London Health Sciences Center, and Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Roberta Berard
- Schulich School of Medicine and Dentistry, Western University, Children's Hospital of Western Ontario, London Health Sciences Center, and Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
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