Spondyloarthritis and inflammatory bowel disease: towards a more severe and refractory disease phenotype

The coexistence of inflammatory bowel disease (IBD) and spondyloarthritis (SpA) poses significant diagnostic and therapeutic challenges. This study aimed to compare clinical characteristics and treatment profiles of patients with both SpA and IBD (SpA/IBD) to those with SpA or IBD alone.

We performed a single-centre observational study including 62 consecutive patients with SpA/IBD followed between 2019 and 2022. Patients met Assessment of SpondyloArthritis International Society 2009 criteria for SpA and had confirmed IBD. Demographics, clinical features, imaging, and biologic disease-modifying antirheumatic drug (bDMARD) usage were collected. For comparison, we included 100 patients with a single diagnosis of SpA or IBD, representing the Maladies Inflammatoires SysTémIques Chroniques cohort enrolled over the same period.

Among patients with SpA/IBD (51% male, 67% HLA-B27+), IBD was more often diagnosed first. Compared with SpA alone, patients with SpA/IBD had more psoriasis (27% vs 17%, P = .04), uveitis (27% vs 18%, P = .08), and smoking (66% vs 44.9%, P = .01), but lower HLA-B27 positivity (63% vs 80%, P = .002). They also received more bDMARDs (2.8 ± 1.7 vs 2.0 ± 1.15, P = .01). Compared with IBD alone, patients with SpA/IBD had higher rates of uveitis (27% vs 1%, P = .08), psoriasis (27% vs 20%, P = .04), smoking (66% vs 44.9%, P = .01), and greater disease activity (Harvey-Bradshaw Index at diagnosis 8.2 ± 5.7 vs 2.6 ± 3.1, P = .0006). Notably, 31.75% met criteria for difficult-to-manage disease, exceeding the 9% reported in SpA monodiagnosis. Combination bDMARD therapy was required in 9.7% of patients with SpA/IBD, significantly more than in single-diagnosis groups (P < .05).

Patients with SpA/IBD exhibit more severe disease and therapeutic challenges, highlighting the need for tailored management and consideration of earlier combination biologic therapies.