Inflammatory Bowel Disease (IBD) is an immune-mediated chronic inflammation of the gastrointestinal tract. In people with IBD the immune system mistakes food, bacteria, and other materials in the intestine for foreign or invading substances. When this happens, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcerations—called autoimmune response. There are two types of IBD, Crohn’s disease and ulcerative colitis.
Ankylosing spondylitis (AS), or a similar form of inflammatory arthritis of the spine is known to occur in association with IBD. In an attempt to determine the frequency of AS in patients with IBD, investigators from the United Kingdom, studied a group of 3000 IBD patients seen over a 17 month period for the presence of inflammatory spine disease.
A verified diagnosis of AS was found to occur in 5% of IBD patients. The average delay to the time of diagnosis was 12 years. The average age of patients was 52 years, and 37% were men. Ulcerative colitis was 74% of the group with the remainder Crohn’s disease. Of interest, 35% of study patients had a family history of spondyloarthritis conditions. Also, only 7% of individuals were HLA-B27 positive. B27 is a genetic marker that is found in almost 90% of patients with classic AS in the absence of gastrointestinal disease.
Patients with IBD and back pain should discuss the risk of AS with their gastroenterologist.
Update To Treat To Target Recommendations for Ankylosing Spondylitis
Experts update treatment recommendations for ankylosing spondylitis.
1. Halling M, Kjeldsen J, Knudsen T, Nielsen J, Hansen L. Patients with inflammatory bowel disease have increased risk of autoimmune and inflammatory diseases. World J Gastroenterol. 2017 Sep 7; 23(33): 6137–6146.
2. Published online 2017 Sep 7. doi: 10.3748/wjg.v23.i33.6137
3. Lim C et al. Prevalence of undiagnosed axial spondyloarthritis among patients with inflammatory bowel disease: A secondary care cross-sectional study [abstract]. Arthritis Rheumatol 2020; 72(suppl 10). https://abstracts.org/abstract/prevalence -of-undiagnosed-axial-spondyloarthritis-among-patients-with-inflammatory-bowel-disease-a-cross-sectional-study