Axial Spondyloarthritis in Inflammatory Bowel Disease: Secondary Care Referral Strategies in Norfolk

Lim, Chong Seng Edwin (2024) Axial Spondyloarthritis in Inflammatory Bowel Disease: Secondary Care Referral Strategies in Norfolk. Doctoral thesis, University of East Anglia.

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Abstract

Background
Axial spondyloarthritis (axSpA) is an inflammatory condition that predominantly affects the axial skeleton, manifesting as chronic back pain (CBP). Referral strategies have focused on expediting suspected axSpA from primary care, but a diagnostic delay remains. Inflammatory bowel disease (IBD) is commonly associated with axSpA. Strategies to identify axSpA in patients with IBD would improve case finding, reduce diagnostic delay, and improve prevalence data for healthcare planning.

Aims
To estimate the frequency of undiagnosed rheumatologist-verified axSpA (RVD-axSpA) diagnosis in IBD patients in the secondary care setting and to demonstrate strategies for their identification in contemporary medical practice.

Methods and Results
In the clinical study, 470 consecutive patients attending gastroenterology clinics were approached. Ninety-one had self-reported CBP >3 months, onset age <45 years, of whom 82 were eligible (gastroenterologist-verified diagnosis, 18–80 years old, biologic therapy naive, no previous diagnosis of axSpA) for assessment. The prevalence of undiagnosed RVD-axSpA is 5% (95% CI 1.3, 12.0). In the imaging study, all abdominopelvic computed tomography (CT) scans for IBD were identified retrospectively from 8 years of imaging archive and limited to 301 (highest diagnostic yield for axSpA: verified IBD diagnosis, 18-55 years old at time of scan). Imaging-compatible changes for axSpA were identified in 60 patients. Of these, 32 responded to participate, and 27 were enrolled. Eight had preexisting axSpA and 5 denied CBP. The remaining 14 patients underwent assessment, three (21.4%, 95% CI 4.7-50.8) of whom had undiagnosed RVD-axSpA. Therefore, at least 5% (3/60) of patients with IBD who had undergone imaging for non-musculoskeletal indications have undiagnosed RVD-axSpA.

Discussion
This project demonstrated a clinical and imaging strategy which together revealed a significant hidden disease burden of undiagnosed RVD-axSpA among IBD patients and outlines a practical modern pilot framework for referral strategies from gastroenterology and radiology, for IBD patients attending secondary care services.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	11 Feb 2025 08:44
Last Modified:	12 Feb 2025 07:48
URI:	https://ueaeprints.uea.ac.uk/id/eprint/98443
DOI:

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