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J Rheumatol. 2019 Jun 1. pii: jrheum.181326. doi: 10.3899/jrheum.181326. [Epub ahead of print]

Impact of gut involvement in patients with high probability of early spondyloarthritis. Data from DESIR cohort.

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From the Rheumatology, CHRU de Besançon (University Teaching Hospital), Boulevard Fleming, 25030 Besançon, France; Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB), Besançon, France; Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE, Besançon, France; Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR center of excellence, Paris , France; INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris 14, France; Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium.



Inflammatory bowel disease (IBD) is a well-known extra articular feature of spondyloarthritis (SpA).The aims of this study were to evaluate in DESIR cohort factors associated with IBD and incidence over 5 years follow-up.


DESIR is a prospective observational cohort of patients with recent onset inflammatory back pain suggestive of axial SpA. All available variables in the database were compared between patients with and without IBD at baseline and 5 years, and occurrence over 5 years of follow-up, with uni and then multivariable analysis.


At baseline, 708 patients, 35 had IBD : prevalence 4.94% [CI 95% : 3.3 - 6.5]. IBD was associated (multivariable) with history of uveitis, levels of DKK-1 and TNF, but not with phenotypic presentation (peripheral arthritis, enthesitis, dactylitis, uveitis) or baseline serum levels of other cytokines. At 5 years, 480 patients were analyzed, 58 with IBD. IBD was associated (multivariable) with fulfillment of modified New York criteria, sick leave, BASDAI, and smoking. No association with MRI scores, enthesitis, psoriasis, BMD. 23 incident cases of IBD were recorded: estimated occurrence rate of 0.95/100 [0.57 - 1.35] patient-years. Incidence of IBD is associated (multivariable) with : HLA B27 : OR 0.36 [0.22 - 0.59], fulfillment of modified New York criteria: OR 3.35 [1.85 - 6.08], familial history of IBD : OR 3.31[1.62 - 6.77] .


in early SpA, IBD occurs with an incidence of 1/100 patient-years, and is associated with poor outcome, familial history of IBD, absence of HLA-B27, fulfillment of modified New York criteria.


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