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Use of synthetic and biological DMARDs in patients with enteropathic spondyloarthritis: a combined gastro-rheumatological approach

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

 

  1. Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy. maria.sole.chimenti@uniroma2.it
  2. Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy.
  3. Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy.
  4. Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy.
  5. Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy.
  6. Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy.
  7. Department of Systems Medicine, Unit of Gastroenterology, University of Rome 'Tor Vergata', Rome, Italy.
  8. Department of Systems Medicine, Unit of Gastroenterology, University of Rome 'Tor Vergata', Rome, Italy.
  9. Department of Systems Medicine, Unit of Gastroenterology, University of Rome 'Tor Vergata', Rome, Italy.
  10. Department of Systems Medicine, Unit of Gastroenterology, University of Rome 'Tor Vergata', Rome, Italy.
  11. Department of Systems Medicine, Unit of Gastroenterology, University of Rome 'Tor Vergata', Rome, Italy.
  12. Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy.

CER11487
2019 Vol.37, N°5
PI 0723, PF 0730
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PMID: 31172920 [PubMed]

Received: 28/06/2018
Accepted : 08/10/2018
In Press: 06/06/2019
Published: 29/08/2019

Abstract

OBJECTIVES:
The aim of this 2-year prospective study was to assess the diagnostic and therapeutic effect of a combined gastro-rheumatological approach in enteropathic spondyloarthritis (eSpA) patients.
METHODS:
Inflammatory bowel disease (IBD) patients with joint pain were referred by IBD-dedicated gastroenterologists to a dedicated rheumatologist. At baseline and at 3, 6, 12, 24 months, the following parameters were recorded: clinical and biochemical variables, SpA and IBD activity scores, treatment (conventional synthetic; csDMARDs, biologics; bDMARDs). Associations between treatment and patient characteristics were evaluated by logistic regression (AOR [95% CI]).
RESULTS:
Overall, 229 IBD patients were referred to rheumatologists. eSpA was diagnosed in 147 (64.2%) patients: 96 (65.3%) showing peripheral and 51 (34.7%) axial involvement. IBD included Crohn’s disease (CD) in 141 (61.6%) and ulcerative colitis (UC) in 88 (38.4%). bDMARD treatment increased over the follow-up (baseline-24 months: 32.7-60%; AOR 3.45 [1.93-6.2], p<0.001). bDMARD use was less frequent in elderly patients (AOR 0.73 [0.56-0.96], p=0.023), in UC (AOR 0.43 [0.2-0.94], p=0.034) and in patients with peripheral involvement (AOR 0.53 [0.3-1.04], p=0.067). csDMARD use was increased in patients with peripheral involvement (AOR 4.65 [2.09-10.33], p<0.001) and in UC (AOR 2.30 [1.13-4.67], p=0.021). CRP, ESR, ASDAS-ESR levels and BASFI significantly decreased over the follow-up, whereas the pMayo score, BASDAI and HAQ-S were unchanged.
CONCLUSIONS:
In this prospective study in eSpA patients, a multidisciplinary approach was shown to optimise the therapeutic management and outcome (e.g. disease activity scores). bDMARD use paralleled an improvement in disease activity scores and confirmed a good safety profile.

Rheumatology Article