Ab0981 high prevalence of irritable bowel syndrome in axial spondyloarthritis: a cross sectional multicentric observational study

Background Axial spondyloarthritis (ax-SpA) is a heterogeneous disease including extra-articular manifestations that can impact both disease severity and quality of life[1]. Among them, gastrointestinal symptoms can be related to inflammatory bowel disease (IBD), but also to functional disorder of the gastrointestinal tract such as irritable bowel syndrome (IBS)[2][3]. IBS and IBD are associated with multiple comorbidities and lifestyle behaviors including diet and physical activity. Objectives The objectives of this study were to evaluate the prevalence of IBS, IBD and associated factors including demographic and ax-SpA characteristics, treatments and adherence, lifestyle behaviors, and comorbidities. Methods A cross-sectional, multicenter study was conducted at rheumatology departments in 5 university hospitals (Bordeaux, Clermont-Ferrand, Limoges, Montpellier, and Toulouse). Patients with ax-SpA (ASAS criteria) treated by biologics were recruited from June 2021 to June 2022. Patients completed an anonymous self-questionnaire evaluating demographic data, lifestyle behaviors, treatment adherence (Girerd questionnaire) and IBS (Roma IV criteria). A medical questionnaire on ax-SpA characteristics, activity and treatments, was completed by rheumatologists. Results 500 patients were included in the study (mean age 49.5±13.8 years, 47 % women, mean disease duration 14.7±11 years, and mean BASDAI 3.6±2.1). Sacroiliitis was observed in 51 % on radiographs and 56 % on MRI, HLA-B27 positivity in 71 %. 86 % of the patients received TNF inhibitors, 13% IL17 inihibitors, 1% IL12/IL23 inhibitors, and 25 % NSAIDs. Good adherence (Girerd score = 0) was reported in 49 % of patients. A medical diet was followed by 26 patients (5%) and non-medical diet by 47 patients (9 %). Most of non-medical diets were lactose (22 patients) and gluten-free diets (11 patients). IBS was present in 124 patients (25 %). Female gender (60 %, p=0.001), unemployment (27 %, p=0.013), higher disease activity (BASDAI, p<0.001), worse functional score (BASFI, p<0.001), multiple lines of biologics (p=0.002), fibromyalgia (34%, p<0.001), anxiety (41%, p<0.001), depression (16%, p=0.037) and lower physical activity (p=0.001) were associated with IBS. No difference was noted regarding diet between patients with or without IBS. IBD was observed in 53 patients (11%). Among them, 41 had Crohn disease (77%), 12 ulcerative colitis (23%), 7/53 being considered active by rheumatologists (15%). Proportion of females was higher (63%, p=0.017) in patients with IBD, whereas HLA-B27 was less present (54%, p=0.016). Patients with IBD received less NSAIDs (p<0.001). The use of TNF inhibitors was as frequent as for patients with no IBD whereas IL17 and IL12/IL23 inhibitors were less frequently used (p=0.01). In contrast to IBS, there was no observed difference in comorbidities and physical activity. The prevalence of IBS was similar between patients with or without IBD (respectively 11/53 (21%) vs. 113/447 (25%)). Conclusion Prevalence of IBS is high in ax-SpA, accounting for a quarter of patients, and should be screened in the presence of gastrointestinal symptoms. The presence of IBS is not associated with IBD, nor diets. It is associated with female gender, anxiety, depression and fibromyalgia. Patients with IBS seem to have a more difficult to treat disease characterized by higher activity, worse functional scores, and multiple lines of treatments. References [1]Stolwijk C, van Tubergen A, Castillo-Ortiz JD, Boonen A. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis. janv 2015;74(1):65‑73. [2]Di Jiang C, Raine T. IBD considerations in spondyloarthritis. Ther Adv Musculoskelet Dis. 2020;12:1759720X20939410. [3]Jouët P, Sabaté JM. Troubles fonctionnels intestinaux et rhumatismes. Rev Rhum Monogr. sept 2016;83(4):213‑7. Acknowledgements I have no acknowledgements to declare. Disclosure of Interests Jessika BERNARD: None declared, Thomas Barnetche Paid instructor for: Biogen, AMORY Charlotte: None declared, DESPRES Jerome: None declared, Maxime VANDERMISSEN: None declared, Justine LANDRIN: None declared, Cédric Lukas Speakers bureau: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, UCB, Consultant of: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, UCB, Grant/research support from: Pfizer, Novartis and Roche-Chugai, Adeline Ruyssen-Witrand Speakers bureau: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Fresenius-Kabi, Galapagos, Janssen, Lilly, MSD, Mylan, Nordic-Pharma, Novartis, Pfizer, Roche Chugai, Sanofi, and UCB, Consultant of: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Fresenius-Kabi, Galapagos, Janssen, Lilly, MSD, Mylan, Nordic-Pharma, Novartis, Pfizer, Roche Chugai, Sanofi, and UCB, Grant/research support from: AbbVie, Amgen, Mylan, Pfizer Inc, Pascale Vergne-Salle Speakers bureau: Abbvie, Fresenius, Grünenthal, Janssen, Pfizer, Roche Chugai, Sanofi, Novartis, Mylan, UCB, Lilly, Consultant of: Janssen, Abbvie, UCB, Anne Tournadre Speakers bureau: Abbvie, Fresenius, Janssen, MSD, Pfizer, Roche Chugai, Sanofi, Paid instructor for: Fresenius, Consultant of: Abbvie, Fresenius, Lilly, Novartis, Sanofi, Grant/research support from: Fresenius, Novartis, Pfizer, UCB.