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P151 Spinal disorders in IBD patients 20 years after diagnosis. Results from the IBSEN study

Ossum A.*1,2, Palm Ø.3, Cvancarova M.4, Moum B.1,2, Høivik M.1

1Oslo university hospital, Gastroenterology, Oslo, Norway 2University of Oslo, Institute of Clinical Medicine, Oslo, Norway 3Oslo university Hospital, Department of Rheumatology, Oslo, Norway 4Oslo and Akershus University College, Faculty of Health Sciences, Oslo, Norway

Background

Patients with inflammatory bowel disease (IBD) often suffer from extraintestinal rheumatic manifestations, prevalently including inflammatory back disorders like ankylosing spondylitis (AS), axial spondylarthropathy (axial SpA) and inflammatory back pain (IBP). However, few studies have estimated the prevalence of these disorders late in the disease course. The aim of this study was to describe the prevalence of inflammatory back disorders 20 years after IBD diagnosis in a well-defined IBD cohort.

Methods

All newly diagnosed cases of IBD in four counties in south-eastern Norway between 1990 and 1993 were included in the IBSEN cohort and followed prospectively. At the 20 year follow-up the patients answered a detailed questionnaire regarding their IBD disease course. Moreover, they were asked about symptoms of inflammatory back disorders and established diagnoses of rheumatic diseases. The patients were classified as having IBP or axial SpA according to the criteria from the Assessment of SpondyloArthritis International Society (ASAS) (IBP if 4 of 5; age at onset<40, insidious onset, pain at night, improvement with exercise, no improvement with rest. Axial SpA criteria; chronic back pain (>3 months) and age at onset<45 plus either radiological sacroiliitis and ≥1 SpA feature or HLA-B27 positivity and ≥2 SpA features).

Results

In total 599 patients from the original cohort were still alive, of those 470 (78.5%) were investigated. Chronic back pain had been present during the disease course in 148 patients (31.5%), 90 (38.3%) women and 58 (24.7%) men. The ASAS criteria for IBP were met by 37 patients (7.9%), 23 women and 14 men, and 17 patients (3.6%) fulfilled the criteria for axial SpA (11 women and 6 men). Over the last 3 months 80 patients (17.0%) reported chronic back pain, leaving only 21 patients (4.5%) fulfilling the IBP criteria and 5 patients (1.1%) the axial SpA criteria. AS was diagnosed in 21 patients (4.5%), 8 women and 13 men. The total HLA-B27 prevalence was 8.7%. The prevalence was higher among patients with chronic back pain, IBP, axial SpA and AS, with 12.8%, 27.0%, 88.7% and 57.1%, respectively.

Conclusion

The prevalence of axial SpA and AS in IBD patients late in the disease course was higher than the prevalence reported in general populations (total SpA 0.4–1.9% and AS 0.1–1.8%) [1], while the prevalence of chronic nonspecific back pain amongst IBD patients was comparable to the general population (reported to be 20% in men and 25–33% in women) [2].

References:

[1] Bakland et al. Current rheumatology reports 2013;15(9).

[2] Sirnes et al. Tidsskr Nor Laegeforen. 2003;123(20).