Diagnosis of Inflammatory Bowel Disease-Associated Peripheral Arthritis: A Systematic Review.

Dana J Lukin, Raymond K Cross, David T Rubin, Brian G Feagan, Joseph Sleiman, Hans Herfarth, Millie D Long, Sara Horst, Katherine Falloon, Florian Rieder, Aditi Patel, Zahra Dossaji, Suha Abushamma, Pooja Mude, Shashank Cheemalavagu, Jean-Fred Colombel, Theresa M Kline, Benjamin L Cohen, Ellen J Scherl, Jaideep Bhalla, Edward V Loftus, Joerg Ermann, Ashwin Ananthakrishnan, Christina Ha, Taha Qazi, Edward L Barnes, Kristine A Kuhn, M Elaine Husni, Samir A Shah, Michael H Weisman, Abhik Bhattacharya, Jason Hou, Bernadette C Siaton

Journal: Inflammatory bowel diseases 2025;31(3):812-842

PMID: 38836521

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Abstract

BACKGROUND

Inflammatory bowel disease (IBD)-associated peripheral spondyloarthritis (pSpA) decreases quality of life and remains poorly understood. Given the prevalence of this condition and its negative impact, it is surprising that evidence-based disease definitions and diagnostic strategies are lacking. This systematic review summarizes available data to facilitate development and validation of diagnostics, patient-reported outcomes, and imaging indices specific to this condition.

METHODS

A literature search was conducted. Consensus or classification criteria, case series, cross-sectional studies, cohort studies, and randomized controlled trials related to diagnosis were included.

RESULTS

A total of 44 studies reporting data on approximately 1500 patients with pSpA were eligible for analysis. Data quality across studies was only graded as fair to good. Due to large heterogeneity, meta-analysis was not possible. The majority of studies incorporated patient-reported outcomes and a physical examination. A total of 13 studies proposed or validated screening tools, consensus, classification, or consensus criteria. A total of 28 studies assessed the role of laboratory tests, none of which were considered sufficiently accurate for use in diagnosis. A total of 17 studies assessed the role of imaging, with the available literature insufficient to fully endorse any imaging modality as a robust diagnostic tool.

CONCLUSIONS

This review highlights existing inconsistency and lack of a clear diagnostic approach for IBD-associated pSpA. Given the absence of an evidence-based approach, a combination of existing criteria and physician assessment should be utilized. To address this issue comprehensively, our future efforts will be directed toward pursuit of a multidisciplinary approach aimed at standardizing evaluation and diagnosis of IBD-associated pSpA.

© The Author(s) 2024. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

Address: Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA.; Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA.; Department of Gastroenterology, Ascension Providence, Southfield, MI, USA.; Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.; Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA.; Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.; Department of Gastroenterology, Mount Sinai Hospital, New York, NY, USA.; Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA.; Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.; Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA.; Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA.; Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA.; Cleveland Clinic Foundation, Cleveland Clinic Library, Cleveland, OH, USA.; Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.; Department of Gastroenterology and Hepatology, Weill Cornell Medical Center, NY, NY, USA.; Department of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA.; Department of Gastroenterology, Brown University, Providence, RI, USA.; Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, MD, USA.; Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.; Department of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA.; Division of Gastroenterology, Department of Medicine, Western University, London, ON, Canada.; Alimentiv Inc., London, ON, Canada.; Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA.; Cleveland Clinic Program for Global Translational Inflammatory Bowel Disease, Cleveland Clinic, OH, USA.; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, OH, USA.

DOI: 10.1093/ibd/izae114

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MeSH Terms: Humans, Inflammatory Bowel Diseases, Patient Reported Outcome Measures, Spondylarthritis, Quality of Life