High Rate of Undiagnosed Axial Spondyloarthritis Among Patients With IBD

There is a high prevalence of undiagnosed axial spondyloarthritis among patients attending inflammatory bowel disease clinics.

A high prevalence of chronic back pain and a substantial hidden burden of axial spondyloarthritis (axSpA) were identified among patients with inflammatory bowel disease (IBD), according to the results of a study published in Rheumatology.

Investigators from Norfolk and Norwich University Hospitals NHS Foundation Trust in the United Kingdom performed this observational, cross-sectional study between 2017 and 2019. Patients (N=173) receiving routine care at IBD clinics were sent a screening questionnaire and underwent a structured clinical assessment for rheumatologist-verified axSpA.

Women made up approximately three-quarters of the study population. The mean age of study participants was 51.9 (standard deviation [SD], 15.0) years, 74.4% had ulcerative colitis, 25.6% had Crohn disease, mean age at onset of IBD was 31.0 (SD, 14.5) years, and 65.9% were in remission, respectively.

All patients experienced chronic back pain, with a mean age of onset of 27.0 (SD, 9.2) years.

Appropriate identification of suspected axSpA patients in IBD clinics offers an opportunity to shorten the delay to diagnosis in axSpA.

Relevant axSpA histories included noninflammatory musculoskeletal conditions (76.8%), a family history of SpA conditions (35.4%), a personal history of SpA conditions (25.6%), and inflammatory peripheral musculoskeletal conditions (15.9%).

Undiagnosed axSpA was estimated to occur in 1% to 5% of the study population. Prevalence all axSpA was 2.3%, symptomatic sacroiliitis was observed among 6.1% of participants, and asymptomatic sacroiliitis was observed among 2.5% of participants.

The mean age of patients who were grouped into the Screen Negative Assessment Control (n=41) cohort was 63 years; 44% were men, 76% had ulcerative colitis, 24% had Crohn disease, and 68% were in remission, respectively. One patient in this cohort was found to have asymptomatic sacroiliitis and another patient was found to have undiagnosed axSpA.

A limitation of this study is that it may have included some selection bias, as all patients were undergoing treatment with biologic therapies for their IBD.

Study authors concluded, “The results of this study have practical implications, as they show that there is undiagnosed rheumatologist-verified axSpA among patients attending secondary care IBD clinics. […] The importance of a clinical diagnosis in axSpA is made clearer by understanding the background of asymptomatic and symptomatic sacroiliitis in IBD patients. Appropriate identification of suspected axSpA patients in IBD clinics offers an opportunity to shorten the delay to diagnosis in axSpA.”

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Lim CSE, Tremelling M, Hamilton L, et al. Prevalence of undiagnosed axial spondyloarthritis in inflammatory bowel disease patients with chronic back pain: secondary care cross-sectional study. Rheumatology. Published online august 22, 2022. doi:10.1093/rheumatology/keac473