Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2 Shinkawa Mitaka, Tokyo, 181-8611, Japan.
Department of General Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan.
Rheumatol Int. 2022 Oct;42(10):1751-1766. doi: 10.1007/s00296-022-05117-0. Epub 2022 May 9.
The purpose of this study was to clarify the clinical characteristics of spondyloarthritis (SpA) patients with inflammatory bowel disease (IBD) compared to those without IBD. Furthermore, among patients with SpA and IBD, we aimed to clarify what clinical characteristics lead rheumatologists to diagnose "IBD-related arthritis." Utilizing SpA and psoriatic arthritis (PsA) patients' data from an international, cross-sectional, observational study, we analyzed information on demographics and disease characteristics, dichotomizing patients by IBD status. The presence or absence of IBD was determined based on data collection of treating rheumatologists. Patients with SpA (including PsA) and IBD were also categorized based on treating rheumatologists' definitive diagnosis in regard to SpA type, and compared by whether the patients had IBD-related arthritis or not. Among 4465 SpA patients, 287 (6.4%, 95%CI 5.7-7.2%) were identified with IBD. Compared to SpA patients without IBD, patients with SpA and IBD had a longer diagnostic delay (5.1 vs. 2.9 years, p < 0.001). In patients with SpA and IBD, 111 (38.7%, 95%CI 33.0-44.6%) were diagnosed with IBD-related arthritis. Multivariable analyses showed that HLA-B27 positivity [OR = 0.35, (95%CI 0.15-0.80)], psoriasis [OR = 0.14, (95%CI 0.04-0.50)], IBD as first symptom of SpA [OR = 3.32, (95%CI 1.84-6.01)], and need for IBD-specific treatment [OR = 5.41, (95%CI 2.02-14.50)] were independently associated with the definitive diagnosis of IBD-related arthritis. Collaboration with gastroenterologists is needed to shorten the diagnostic delay in patients with SpA and IBD. The recognition of the factors for the diagnosis of "IBD-related arthritis" may lead to the elucidation of the pathogenesis.
本研究旨在阐明伴有炎症性肠病（IBD）的脊柱关节炎（SpA）患者与不伴 IBD 的 SpA 患者的临床特征。此外，我们旨在阐明 SpA 伴 IBD 患者中哪些临床特征导致风湿病医生诊断为“与 IBD 相关的关节炎”。利用一项国际、横断面、观察性研究中 SpA 和银屑病关节炎（PsA）患者的数据，我们分析了人口统计学和疾病特征信息，并根据 IBD 状态对患者进行了二分法。IBD 的存在与否是根据风湿病医生的数据收集来确定的。根据风湿病医生对 SpA 类型的明确诊断，将 SpA（包括 PsA）伴 IBD 的患者进行分类，并根据患者是否患有与 IBD 相关的关节炎进行比较。在 4465 名 SpA 患者中，287 名（6.4%，95%CI 5.7-7.2%）被诊断为 IBD。与不伴 IBD 的 SpA 患者相比，伴 IBD 的 SpA 患者的诊断延迟时间更长（5.1 年 vs. 2.9 年，p<0.001）。在 SpA 伴 IBD 的患者中，111 名（38.7%，95%CI 33.0-44.6%）被诊断为与 IBD 相关的关节炎。多变量分析显示，HLA-B27 阳性[OR=0.35，（95%CI 0.15-0.80)]、银屑病[OR=0.14，（95%CI 0.04-0.50)]、SpA 首发 IBD[OR=3.32，（95%CI 1.84-6.01)]和需要 IBD 特异性治疗[OR=5.41，（95%CI 2.02-14.50)]与 IBD 相关关节炎的明确诊断独立相关。需要与胃肠病学家合作，以缩短 SpA 伴 IBD 患者的诊断延迟。认识到“与 IBD 相关的关节炎”诊断的因素可能有助于阐明发病机制。
