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P064 The role of fecal calprotectin in the prediction of ankylosing spondylitis associated with early IBD

L. Dávida*1, S. Szántó2, S. Kacska1, B. Haraszti1, B. Brúgós3, I. Altorjay1, Z. Szekanecz2, K. Palatka1

1University Of Debrecen, Institute Of Internal Medicine, Department Of Gastroenterology, Debrecen, Hungary, 2University Of Debrecen, Institute Of Internal Medicine, Department Of Rheumatology, Debrecen, Hungary, 3University Of Debrecen, Institute Of Internal Medicine, Department Of Rare Diseases, Debrecen, Hungary

Background

Ankylosing spondylitis (AS) and inflammatory bowel diseases (IBD) are both chronic inflammatory diseases with unknown etiology, their pathogenic and ethiological characteristics are similar in many ways. 20 percent of patients with IBD have musculoskeletal involvement, whereas in 40-60 percent of patients with AS microscopic or macroscopic signs of inflammation concerning the gastrointestinal tract can be detected.

Methods

The aim of the study was to detect gut inflammation by measuring fecal calprotectin (fCal) levels, performing colonoscopy with multiple biopsy samples. We investigated the relationship of fecal calprotectin levels with symptoms, endoscopic lesions, activity indices.

Results

19 patients were recruited (12M, 7 FM). The average age of AS patients were 40 years (19-63 years), the average disease duration was 13,4 years. 63% of the patients were male, 84% were HLA-B27 positive. Median fCal level was 162 µg/g. The stool samples of 57% of AS patients were positive for fCal when using the manufacturer's cutoff value for positivity of 30 ug/g. The colonoscopies showed macroscopic and/or microscopic signs of inflammation in ileum or colon in 58% of patients, and in the fCal positive group 81,8% of patients showed evidence of inflammation during colonoscopy (in the fCal negative group only 12,5%). The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was not significantly different in the fCal positive and negative group (3,84 points vs. 3,74 points). Fecal calprotectin levels showed no association with disease duration, ESR level. The CRP levels were significantly higher in the fCal positive group than in the negative group (15,42 mg/L vs 4,68 mg/L). Before our study 3 of the patients were already diagnosed with IBD, the bowel disease appeared years after the diagnosis of the spondylarthropathy.

Conclusion

AS and IBD may associate with each other, therefore on patients with AS a screening fecal calprotectin test should be performed to diagnose early IBD. The detected endoscopic lesions and microscopic colitis can be regarded as early IBD forms, these patients are suggested to be monitored.