SAT0355 IRRITABLE BOWEL SYNDROME SYMPTOMS IN AXIAL SPONDYLOARTHRITIS AND HEALTHY CONTROLS, AND THEIR RELATION TO DISEASE CHARACTERISTICS – IS IT AN OVERLOOKED COMORBIDITY?
Authors: Johan K. Wallman, Elisabeth Mogard, Jan Marsal, Kristofer Andréasson, Anna Jöud, Mats Geijer, Lars Erik Kristensen, Elisabet Lindqvist, Tor Olofsson
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> While inflammatory bowel disease (IBD) is a well-known comorbidity in axial spondyloarthritis (axSpA), little is known about the prevalence, drivers and impact of irritable bowel syndrome (IBS). In the general population, the IBS prevalence has been estimated to ∼11%.[1] <h3>Objectives</h3> To compare the frequency of gut symptoms meeting IBS criteria between axSpA patients and controls, and to examine how such symptoms relate to disease characteristics. <h3>Methods</h3> Consecutive axSpA patients were examined and classified as non-radiographic axial SpA (nr-axSpA; ASAS criteria; n=63) or ankylosing spondylitis (AS; modified New York criteria; n=119), excluding cases with known IBD. Proportions reporting gut symptoms meeting the ROME III IBS criteria were compared between axSpA patients and sex and age matched controls (without rheumatic disease or IBD; n=50) by logistic regression.[2] Within the axSpA group, separate logistic regression models were also applied to examine whether the presence of IBS symptoms differed according to disease subtype (nr-axSpA/AS), sex, disease activity, level of systemic and gut inflammation, NSAID and DMARD use, and comorbid fibromyalgia (according to the 1990 fibromyalgia criteria).[3] Finally, we analysed associations between the presence of IBS symptoms and standard patient-reported axSpA outcomes and evaluator's VAS global assessment of disease activity. All analyses were sex and age adjusted. <h3>Results</h3> Symptoms meeting IBS criteria were significantly more common among axSpA patients (30%) than controls (16%; OR 2.5 [95%CI 1.1-5.7]; <b>Figure 1A</b>). Within the axSpA group, no difference was observed between nr-axSpA and AS (<b>Figure 1B</b>). Furthermore, no associations were observed with markers of systemic or gut inflammation, whereas the presence of IBS symptoms was significantly more frequent among patients with higher disease activity (OR 2.2 [95%CI 1.1-4.5] for ASDAS-CRP ≥2.1 vs. &lt;2.1), in females (OR 3.0 [1.5-5.8] vs. men), among NSAID users (OR 2.3 [1.1-4.6] vs. non-users), and in patients fulfilling fibromyalgia criteria (OR 3.0 [1.0-8.6] vs. not); <b>Figure 1B</b>). All patient-reported outcomes, but not evaluator's VAS global, were significantly worse in patients reporting IBS symptoms (<b>Table</b>). <h3>Conclusion</h3> In axSpA patients without an IBD diagnosis, gut symptoms meeting IBS criteria were twice as common as in healthy controls. While IBS symptoms do not appear to be driven by subclinical gut inflammation or systemic inflammation, the associations with criteria-assessed fibromyalgia, female sex, and worse levels of patient-reported outcomes indicate a link to central pain sensitization, although side effects of NSAIDs may also play a role. <h3>References</h3> [1] Lovell RM, et al. Clin Gastroenterol Hepatol. 2012;10:712-21. [2] Drossman DA. Gastroenterology. 2006;130:1377-90. [3] Wolfe F, et al. Arthritis Rheum. 1990;33:160-72. <h3>Acknowledgement</h3> Miriam Walsh Ingelström, research nurse. <h3>Disclosure of Interests</h3> Johan K Wallman Consultant for: Consultant for AbbVie, Celgene, Eli Lilly, Novartis, and UCB Pharma., Elisabeth Mogard: None declared, Jan Marsal Grant/research support from: Grant/research support from AbbVie, Ferring, and Pfizer., Consultant for: Consultant for AbbVie, BMS, Ferring, Hospira, Janssen-Cilag, MSD, Otsuka, Pfizer, Sandoz, Svar Life Science, Takeda, Tillotts, and UCB Pharma., Kristofer Andréasson: None declared, Anna Jöud: None declared, Mats Geijer Consultant for: Consultant for AbbVie, Novartis, and Pfizer., Lars Erik Kristensen Grant/research support from: UCB, Biogen, Janssen Pharmaceuticals, and Novartis, Consultant for: Consultant for AbbVie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB Pharma., Speakers bureau: Pfizer, AbbVie, Amgen, UCB, BMS, Biogen, MSD, Novartis, Eli Lilly and Company, and Janssen Pharmaceuticals, Elisabet Lindqvist: None declared, Tor Olofsson: None declared