Axial spondylitis and inflammatory bowel disease: a bi-directional association explored by demographic, clinical-genetic factors

Abstract

Background. Axial spondylitis (AxSpA) - chronic inflammatory disease of the axial skeleton, often associated with inflammatory bowel disease (IBD). With an estimated prevalence of 1.5-2%, both share similar immunological mechanisms, and their correlation is essential for personalized management and better prognosis. Objective(s). Evaluation of baseline characteristics, prevalence of inflammatory bowel disease (IBD) and investigation of correlations between AxSpA and IBD, focusing on demographic, clinical and genetic factors. Materials and methods. A prospective observational study conducted on two patient cohorts: AxSpA (n=257) and IBD, selected from rheumatology and gastroenterology clinics, meeting the inclusion criteria for axSpA (ASAS) or IBD. Statistical analyses, including multivariable logistic regression, were performed using SPSS v22.0, with significance set at p<0.05. Results. Of 257 patients with AS, 13 (5.1%) were diagnosed with IBD, including Crohn's disease (3.1%), ulcerative colitis (1.2%), and indeterminate colitis (0.8%). The prevalence of IBD was higher in patients without a family history of AxSpA (7.8% vs. 2.4%, p=0.048) and increased with disease duration. IBD preceded AxSpA in 53.8% of cases with a mean of 10 years. Extraarticular manifestations: conjunctivitis, nail hyperkeratosis, were present in 43.6% of patients with AxSpA and were associated with a higher prevalence of IBD. Multivariable analysis identified the absence of a family history of Axial spondylitis as a significant risk factor for IBD (OR=3.4; p=0.025). Conclusion(s). The prevalence of IBD in patients with AxSpA emphasizes the need for integrated monitoring of gastrointestinal symptoms and gastroenterologist-rheumatologist collaboration, and early detection and management of IBD in patients with AxSpA could improve overall clinical outcomes and quality of life.