AB0871 COMPARING SCREENING TOOLS FOR IDENTIFYING SPONDYLOARTHRITIS IN INDIVIDUALS WITH INFLAMMATORY BOWEL DISEASE
Authors: A. Zabotti, N. Cabas, S. Cacioppo, I. Giovannini, S. Sacco, C. Zoratti, M. Marino, S. De Vita, L. Quartuccio
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Spondyloarthritis (SpA) is the most common extraintestinal manifestation in inflammatory bowel disease (IBD). Patients with SpA related to IBD (IBD related SpA) usually develop arthritis after the diagnosis of IBD<sup>1</sup>. Detecting SpA at an early stage enhances the possibility of achieving complete remission of disease, thereby improving patient care through the use of drugs that could work both for gut and joint. <h3>Objectives:</h3> i) to determine the sensitivity and the specificity of two questionnaires, the IBd Identification of Spondyloarthritis Questionnaire (IBIS-Q)<sup>2</sup> and the DETection of Arthritis in Inflammatory bowel diseases (DETAIL)<sup>3</sup>, both used to investigate signs and symptoms suggestive of IBD-related SpA. Ii) to describe the clinical phenotype of the undiagnosed IBD related SpA. <h3>Methods:</h3> Between April and October 2023, both IBIS-q and DETAIL<sup>2,3</sup> questionnaire were administered to consecutive IBD outpatients attending the University Hospital of Udine, Italy. During the routine gastroenterology evaluation, patients aged between 18-75 years, affected by Crohn disease (CD) or ulcerative colitis (UC) were asked to fill both the questionnaires. Subsequently, all the patients who completed the questionnaires were referred to a blinded rheumatological evaluation within 2 weeks. Patients with a previous diagnosis of IBD related SpA or other forms of inflammatory arthritis were subsequently excluded. The new IBD related SpA diagnosis was attributed in the case of rheumatological diagnosis and fulfillment of ASAS criteria. <h3>Results:</h3> A total of 203 patients were initially included in the study, but 26 out of 203 (12.8%) were excluded due to a pre-existing diagnosis of arthritis (Figure 1A). Among the remaining 177 patients, 11 out of 177 (6.2%) were newly diagnosed with IBD related SpA. The DETAIL questionnaire (with a cut-off ≥3) exhibited a sensitivity of 36.66% (95% CI 10.93%-69.21%) and a specificity of 84.34% (95% CI 77.90% to 89.51%) for SpA diagnosis (Figure 1B), while the IBIS-Q questionnaire (cut-off ≥3) demonstrated a sensitivity of 63.64% (95% CI: 30.79-89.07%) and a specificity of 74.10% (95% CI 66.74% to 80.58%) (Figure 1B). Regarding the new cases of IBD related SpA, imaging confirmed enthesitis was the predominant pattern in 8 out of 11 cases (72.7%, 8/8 without concomitant peripheral arthritis), axial involvement in 2 out of 11 (18.2%), and peripheral arthritis in 1 out of 11 (9.1%) (Figure 2). The median duration of musculoskeletal symptoms before the IBD related SpA diagnosis was 6 months. <h3>Conclusion:</h3> The number of patients with undiagnosed IBD related SpA is low but not negligible and this study underscores how enthesitis, even in the absence of synovitis, could be the initial sign of disease creating a specific challenge in early disease recognition. Furthermore, in our study IBIS-Q exhibited higher sensitivity but lower specificity compared to DETAIL in identifying patients with IBD related SpA. <h3>REFERENCES:</h3> [1] <i>Rodríguez-Reyna TS et al, 2009 Nov 28;15(44):5517-24. doi: 10.3748/wjg.15.5517.</i> [2] <i>Variola A et al, J Crohns Colitis. 2020 Dec 2;14(12):1680-1686.</i> [3] <i>Benfaremo D et al, J Rheumatol. 2021 Feb;48(2):179-187.</i> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>