Prevalence of undiagnosed axial spondyloarthritis in inflammatory bowel disease patients with chronic back pain: secondary care cross-sectional study

Chong Seng Edwin Lim, Mark Tremelling, Louise Hamilton, Matthew Kim, Alexander MacGregor, Tom Turmezei, Karl Gaffney

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
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Objective: To elucidate the prevalence of undiagnosed rheumatology-verified diagnosis of axial spondyloarthritis (RVD-axSpA) in patients attending routine secondary care IBD clinics with chronic back pain.  

Methods: Screening questionnaires were sent to consecutive patients attending IBD clinics in a university teaching hospital. Patients fulling the eligibility criteria (gastroenterologist-verified diagnosis, 18–80 years old, biologic therapy naive, no previous diagnosis of axSpA); and a moderate diagnostic probability of axSpA [self-reported chronic back pain (CBP) >3 months, onset <45 years] were invited for rheumatology assessment. This included medical review, physical examination, patient reported outcome measures, human leucocyte antigen B27, C-reactive protein, pelvic radiograph and axSpA protocol magnetic resonance imaging. A diagnosis of RVD-axSpA was made by a panel of rheumatologists.  

Results: Of the 470 patients approached, 91 had self-reported CBP >3 months, onset <45 years, of whom 82 were eligible for clinical assessment. The prevalence of undiagnosed RVD-axSpA in patients attending IBD clinics in a secondary care setting, with self-reported CBP, onset <45 years is estimated at 5% (95% CI 1.3, 12.0) with a mean symptom duration of 12 (S.D. 12.4) years.  

Conclusion: There is a significant hidden disease burden of axSpA among IBD patients. Appropriate identification and referral from gastroenterology is needed to potentially shorten the delay to diagnosis and allow access to appropriate therapy.  
Original languageEnglish
Pages (from-to)1511-1518
Number of pages8
Issue number4
Early online date22 Aug 2022
Publication statusPublished - 3 Apr 2023


  • axial spondyloarthritis
  • back pain
  • epidemiology
  • inflammatory bowel disease
  • magnetic resonance imaging

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