P424 Do antiTNF through levels correlate with joint extraintestinal manifestations (EIM) activity in Inflammatory bowel disease (IBD) patients?

Madero Velázquez, L.(1)*;Jovani, V.(2);Andrés, M.(3);Más, P.(4);Aguas, M.(5);Vicens, E.(6);Ojeda, A.(7);Noguera-Pons, J.R.(8);Ranieri, L.(9);Zabana, Y.(10);Pujol, M.(11);Barreiro de Acosta, M.(12);Pérez-Pampin, E.(13);Bernal, L.(14);Belen, O.(14);Moreno, V.(14);García, M.F.(15);Sempere, L.(1);Zapater, P.(16);Gutiérrez Casbas, A.(17);

(1)Hospital General Universitario Dr Balmis de Alicante- ISABIAL, Gastroenterology, Alicante, Spain;(2)Hospital General Universitario Dr Balmis de Alicante- ISABIAL, Reumatology, Alicante, Spain;(3)Hospital General Universitario Dr Balmis de Alicante- ISABIAL- Departamento Medicina Clínica Universidad Miguel Hernández, Reumatology, Alicante, Spain;(4)Hospital General Universitario Dr Balmis de Alicante- ISABIAL, Farmacia hospitalaria, Alicante, Spain;(5)Hospital Policlínico Universitario La Fé, Gastroenterology, Valencia, Spain;(6)Hospital Policlínico Universitario La Fé, Reumatology, Valencia, Spain;(7)Hospital General Universitario Elche, Gastroenterology, Alicante, Spain;(8)Hospital General Universitario de Elche, Reumatology, Alicante, Spain;(9)Hospital Vinalopó, Reumatology, Elche, Spain;(10)Hospital Universitari Mútua Terrassa. CIBERehd, Gastroenterology, Barcelona, Spain;(11)Hospital Universitari Mútua Terrassa, Reumatology, Barcelona, Spain;(12)Hospital Clínico Universitario de Santiago de Compostela. Universidad De Santiago de Compostela, Gastroenterology, Santiago de Compostela, Spain;(13)Hospital Clínico Universitario de Santiago de Compostela, Reumatology, Santiago de Compostela, Spain;(14)Hospital General Universitario Dr Balmis de Alicante, Gastroenterology, Alicante, Spain;(15)Hospital General Universitario de Elche, Gastroenterology, Alicante, Spain;(16)Hospital General Universitario Dr Balmis de Alicante- ISABIAL. Universidad Miguel Hernández- IDiBE-CIBERehd, Clinical Pharmacology, Alicante, Spain;(17)Hospital General Universitario Dr Balmis de Alicante- ISABIAL. CIBERehd, Gastroenterology, Alicante, Spain;


Inflammatory arthropathies are the most common EIM associated to IBD with a prevalence of 20-50% for axial inflammation and 5-20% for peripheral arthritis. AntiTNF is the preferred treatment in patients with axial spondiloarthritis (AxSp) intolerant or refractory to NSAIDs and has shown efficacy in peripheral arthritis (pSp) as well. Nevertheless, an optimal antiTNF through level has not been yet stablished in this clinical setting. Thus, our aims were to evaluate the correlation between antiTNF through levels and joint EIM activity in IBD patients.


We conducted a prospective, multicenter cohort study. IBD patients diagnosed with articular EIM (AxSp, pSp or both) under antiTNF treatment at least 6 months were included. Anti-TNF concentrations were measured using ELISA. Blood samples were obtained just before the administration of the drug (trough levels), and an simultaneous evaluation by a reumatologist was performed. Definitions: inactive AxSp = ASDAS-CRP <1,3 and BASDAI<2 , low active AxSp: ASDAS-CRP <2,1 and BASDAI<4; inactive pSp=arthritis, enthesitis and dactylitis=0, low active pSp: arthritis, enthesitis and dactylitis ≤1. IBD activity was based on partial Mayo score for ulcerative colitis (UC) patients and on Harvey-Bradshaw score for Crohn´s disease (CD) patients.


A total of 78 patients were included: Median age 52 ±15, 45% women, 82%  CD (56% ileal; 18% colic; 24% ileocolic; 2% upper gastrointestinal involvement; 22% stricturing behaviour; 16% penetrating; 14% perianal disease), 18% UC (61% extensive, 15% left-sided, 23% proctitis), 11% had another EIM. HLA B-27 was present in 26% patients. Distribution of spondiloartrhopaties was: AxSp 42%, pSp 37%, or both 20%. Among CD patients, 18,9% presented clinical activity (n=14). Mean IBD disease duration was 11± 9,7 years. Fourteen patients (18%) were also under immunosupressive treatment .Through levels distributed by joint activity are shown in table 1.Figure 1 shows distribution of adalimumab through levels by AxSp activity.


No correlation between antiTNF through levels and joint EIM activity was found in these preliminary results. However, patients with active axial Sp treated with adalimumab had lower through levels than those with inactive axial Sp.