POS0968 ARE THERE CLUES FOR THE SCREENING OF SPONDYLOARTHRITIS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES?
Authors: B. Farisoğullari, O. Keskin, B. Usta, G. K. Yardimci, E. Parlak, T. Kav, O. Karadag, U. Kalyoncu
Journal: Annals of the Rheumatic Diseases (2021)

Background: SpA is the most frequent extra-intestinal manifestation in patients with IBD (1). Questioning IBD patients in terms of SpA and referring patients to the rheumatology clinic is important for early diagnosis and treatment management. Objectives: We aimed to diagnose SpA early by using the DETAIL questionnaire to IBD patients and to compare it with the study validated for each question (2). Methods: In the Hacettepe University Gastroenterology Clinic, patients with IBD were questioned for musculoskeletal symptoms between March 2019 and September 2020. For this purpose, a validated DETAIL questionnaire consisting of 6 questions was asked. Patients with at least 1 positive out of 6 questions were consulted in the rheumatology clinic, and patients were evaluated for SpA by physical examination, laboratory, and imaging. For each question in the detection of arthritis in inflammatory bowel diseases (DETAIL) questionnaire, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio (LR) were calculated. Results: 217 IBD patients were included in the study. Twenty patients with previously known rheumatologic diseases were excluded from the study. 49 (24%) of the remaining 197 patients had a positive answer to at least one question in the DETAIL query. 39 (20%) of these patients were evaluated in the rheumatology clinic, and 16 (8.1%) of them were diagnosed with SpA (spondylitis: 9, peripheral arthritis: 7) (Figure 1). In the DETAIL questionnaire, two patients answered 5/6 yes, five patients answered 4/6 yes, eleven patients answered 3/6 yes, ten patients answered 2/6 yes, and eleven patients answered 1/6 yes. In the six items of DETAIL, the best performances in discriminating patients affected by SpA were found in the second and fourth questions (LR + 2.9 and 1.57, respectively) (Table 1). Conclusion: 41% of IBD patients who answered yes to at least one question in the DETAIL questionnaire were diagnosed with SpA. Especially those with sausage fingers or low back pain for at least 3 months seem more likely probability to be diagnosed with SpA. Unlike the validated study, the probability of having diagnosis of SpA was not observed in questions five and six, which questioning the inflammatory back pain parameters. The DETAIL questionnaire may be used as a useful screening tool for the detection of SpA. References: [1]Fragoulis GE et al. Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment. World J Gastroenterol. 2019;25(18):2162-76. [2]Benfaremo D et al. Multicenter validation of the DETAIL questionnaire for the screening of spondyloarthritis in patients with inflammatory bowel diseases. The Journal of Rheumatology, 2020. Table 1. Sensitivity, specificity, positive and negative predictive values, likelihood ratios of the DETAIL questionnaire both in our study and in the other study DETAIL questionnaire Questions Sensitivity (% ) Specificity (% ) Positive predictive value (% ) Negative predictive value (% ) Positive likelihood ratio Negative likelihood ratio Current study Other study Current study Other study Current study Other study Current study Other study Current study Other study Current study Other study 1. Have you ever had a finger or a toe and/or another joint swollen and painful for no apparent reason? 68.8 69.6 34.8 67.7 42.3 41 61.5 87.3 1.05 2.16 0.9 0.45 2. Occasionally, has an entire finger or toe becomes swollen, making it look like a ‘sausage’? 12.5 27.4 95.7 89.2 66.7 45.1 61.1 79.2 2.9 2.55 0.91 0.81 3. Have you had pain in your heels? 43.6 45.1 56.5 86.3 41.2 51.6 59.1 82.9 1.01 3.3 0.99 0.64 4. Have you ever had back pain lasting at least 3 months that was not injury related? 75 77.4 52.2 73.4 52.2 48.4 75 90.9 1.57 2.9 0.48 0.31 5. Do you have low back pain in the morning and/or after resting that improves with exercise? 43.6 82.3 56.5 67.7 41.2 45.1 59.1 92.2 1.01 2.5 0.99 0.26 6. Do you wake up at night because of low back pain? 18.8 54.9 78.3 85.4 37.5 54.9 58.1 85.4 0.87 3.7 1.04 0.53 Figure 1. Flow chart of IBD patients in the study Disclosure of Interests: None declared.