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.
B. Laganà, MD, A. Picchianti-Diamanti, MD, PhD, Department of Clinical and Molecular Medicine, S. Andrea University Hospital, "Sapienza" University, Rome.
J Rheumatol. 2021 Feb;48(2):179-187. doi: 10.3899/jrheum.200364. Epub 2020 Jul 15.
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.
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.
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.
The DETAIL questionnaire is a useful tool for the early detection of SpA in IBD.
脊柱关节炎（SpA）是炎症性肠病（IBD）最常见的肠外表现之一。在这项研究中，我们旨在验证 DETECTION OF Arthritis IN INFLAMMATORY boweL diseases（DETAIL）问卷在 11 个胃肠病学单位招募的 IBD 患者多中心队列中的有效性。
从 2018 年 10 月到 2019 年 3 月，连续的成年 IBD 患者（克罗恩病或溃疡性结肠炎）在门诊等候室独立填写 DETAIL 问卷。在 2 周内，一位盲法风湿病学家对所有患者进行评估，无论 DETAIL 结果如何，将他们分为是否患有 SpA。通过贝叶斯分析评估问题的表现。
总体而言，418 名 IBD 患者填写了 DETAIL 问卷。在风湿病学评估中，102 名（24.4%）患者被诊断为 SpA。在 6 个问题中，表现最好的是第 6 个问题[阳性似然比（LR）+3.77]，报告夜间炎症性背痛，第 3 个问题（LR+3.31），探讨跟腱附着点炎。存在持续>3 个月的背痛（LR+2.91）、伴有炎症特征的背痛（LR+2.55）和病史的指（趾）炎（LR+2.55），也表现出相当好的性能，而外周关节炎史稍差（LR+2.16）。至少有 3 个问题回答肯定的组合得出 SpA 的后验概率为 80%或更高。存在其他诊断，如骨关节炎或纤维肌痛，代表一个较小的混杂因素。
DETAIL 问卷是一种用于早期发现 IBD 中 SpA 的有用工具。
