6ffb6cd4838f989438be9e1e72cfad4b 327733.pdf 700b570f501653d528dbdb4fc1081c6e34b59258 327733.pdf 57a4b96aa82c12538b3345a28265829f37ed3b0a087b66f58c8cf7f79793133b 327733.pdf Title: Prevalence of Undiagnosed Inflammatory Bowel Disease in Spondyloarthritis Patients Subject: Background/Objectives: The prevalence of inflammatory bowel disease (IBD) in spondyloarthritis (SpA) patients is unknown. Our objective was to assess the prevalence of undiagnosed IBD in SpA patients, including those with axial spondylarthritis (axSpA) or psoriatic arthritis (PsA). Additionally, we examined fecal calprotectin (FC) levels in relation to the accuracy of IBD diagnosis. Methods: EISER was a cross-sectional, multicenter, observational, rheumatologist–gastroenterologist collaborative study. Patients with SpA naïve to biologics were recruited. Demographic and clinical characteristics, disease activity, and treatment information were collected. Patients with FC 80 g/g or IBD-related symptoms underwent a colonoscopy or video capsule endoscopy. Receiver operating characteristic analysis assessed the predictive value of FC for IBD diagnosis. Results: Of the 570 patients recruited, 494 were evaluable for the main outcome, 248 (50.2%) had axSpA, and 246 (49.8%) had PsA. Overall, 28/494 patients were diagnosed with IBD (5.7%, 95%CI 3.6–7.7). Sorted by clinical entity, 22 (8.9%, 95%CI 5.3–12.4) axSpA and 6 (2.4%, 95%CI 0.5–4.4) PsA patients had a diagnosis of IBD: 24 (86%, 95%CI 79.4–92.6) had ileal/ileocolonic Crohn’s disease (CD), 3 (11%, 95%CI 5.1–16.9) unclassified IBD, and 1 (3.5%, 95%CI 0.0–6.9) ulcerative colitis. The ROC curve for FC and IBD diagnosis (AUC: 0.870, p < 0.001, 95%CI 83.7–89.8) showed that an FC 147 g/g had a positive predictive value of 17.4% (95%CI 14.5–20.8) Conclusions: In SpA, the prevalence of undiagnosed IBD was 5.7%, higher in axSpA (8.9%) than in PsA (2.4%) patients, with CD being the most common. SpA patients with FC levels < 147 g/g had a very low probability of IBD. Keywords: prevalence undiagnostic; inflammatory bowel disease; fecal calprotectin; axial spondylarthritis; psoriatic arthritis Author: Jesús Sanz-Sanz, Ana Gutiérrez-Casbas, Zulema Plaza, Jordi Gratacós, Iago Rodríguez-Lago, Ignacio Marín-Jiménez, Elisa Trujillo-Martín, Eva Pérez-Pampín, Manuel Barreiro-de Acosta, María Vanesa Hernández-Hernández, Marta Carrillo-Palau, María Luz García-Vivar, María Carmen Muñoz-Villafranca, Maria Lourdes Ladehesa-Pineda, Eva Iglesias-Flores, Carolina Merino-Argumánez, Yago González-Lama, Marta Arévalo-Salaet, Xavier Calvet and Federico Díaz-Gonzalez Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Fri Jun 27 14:35:37 2025 CEST ModDate: Fri Jun 27 14:38:49 2025 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 576948 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- MIKRSI+VnURWPalladioL Type 1 Custom yes yes yes 10 0 FFSZRR+URWPalladioL-Roma Type 1 Custom yes yes yes 16 0 DDSXSP+URWPalladioL-Bold Type 1 Custom yes yes yes 22 0 WTBNAL+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 OVNEXW+EURM10 Type 1 Builtin yes yes yes 53 0 JGMOZW+CMSY10 Type 1 Builtin yes yes yes 58 0 KOOLCC+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 75 0 KOOLCE+PalatinoLinotype TrueType WinAnsi yes yes no 78 0 KOOLCG+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 81 0 XIRVNA+EURB10 Type 1 Builtin yes yes yes 90 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 95 0 FHBIAZ+EURB7 Type 1 Builtin yes yes yes 106 0 KOOOEJ+TimesNewRoman CID TrueType Identity-H yes yes yes 117 0 KOOOFK+TimesNewRoman TrueType WinAnsi yes yes no 123 0 KOOOFM+TimesNewRoman,Italic TrueType WinAnsi yes yes no 126 0 KOOLCE+PalatinoLinotype TrueType WinAnsi yes yes no 129 0 KOOLCG+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 132 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-04-29 04:13:36 CEST RepresentationInformation: 327733.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-04-28 13:43:03 CEST Size: 576948 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 307 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Study Design Destination: subsection.2.1 Item: Title: Selection Criteria Destination: subsection.2.2 Item: Title: Study Procedures and Assessments Destination: subsection.2.3 Item: Title: Statistical Analysis Destination: subsection.2.4 Item: Title: Results Destination: section.3 Children: Item: Title: Patients’ Disposition and Characteristics Destination: subsection.3.1 Item: Title: Fecal Calprotectin Levels Destination: subsection.3.2 Item: Title: Prevalence of Inflammatory Bowel Disease Destination: subsection.3.3 Item: Title: Diagnostic Performance of Fecal Calprotectin Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: appendix.A. Info: Title: Prevalence of Undiagnosed Inflammatory Bowel Disease in Spondyloarthritis Patients Author: Jesús Sanz-Sanz, Ana Gutiérrez-Casbas, Zulema Plaza, Jordi Gratacós, Iago Rodríguez-Lago, Ignacio Marín-Jiménez, Elisa Trujillo-Martín, Eva Pérez-Pampín, Manuel Barreiro-de Acosta, María Vanesa Hernández-Hernández, Marta Carrillo-Palau, María Luz García-Vivar, María Carmen Muñoz-Villafranca, Maria Lourdes Ladehesa-Pineda, Eva Iglesias-Flores, Carolina Merino-Argumánez, Yago González-Lama, Marta Arévalo-Salaet, Xavier Calvet and Federico Díaz-Gonzalez Subject: Background/Objectives: The prevalence of inflammatory bowel disease (IBD) in spondyloarthritis (SpA) patients is unknown. Our objective was to assess the prevalence of undiagnosed IBD in SpA patients, including those with axial spondylarthritis (axSpA) or psoriatic arthritis (PsA). Additionally, we examined fecal calprotectin (FC) levels in relation to the accuracy of IBD diagnosis. Methods: EISER was a cross-sectional, multicenter, observational, rheumatologist gastroenterologist collaborative study. Patients with SpA naïve to biologics were recruited. Demographic and clinical characteristics, disease activity, and treatment information were collected. Patients with FC 80 g/g or IBD-related symptoms underwent a colonoscopy or video capsule endoscopy. Receiver operating characteristic analysis assessed the predictive value of FC for IBD diagnosis. Results: Of the 570 patients recruited, 494 were evaluable for the main outcome, 248 (50.2%) had axSpA, and 246 (49.8%) had PsA. Overall, 28/494 patients were diagnosed with IBD (5.7%, 95%CI 3.6 7.7). Sorted by clinical entity, 22 (8.9%, 95%CI 5.3 12.4) axSpA and 6 (2.4%, 95%CI 0.5 4.4) PsA patients had a diagnosis of IBD: 24 (86%, 95%CI 79.4 92.6) had ileal/ileocolonic Crohn’s disease (CD), 3 (11%, 95%CI 5.1 16.9) unclassified IBD, and 1 (3.5%, 95%CI 0.0 6.9) ulcerative colitis. The ROC curve for FC and IBD diagnosis (AUC: 0.870, p < 0.001, 95%CI 83.7 89.8) showed that an FC 147 g/g had a positive predictive value of 17.4% (95%CI 14.5 20.8) Conclusions: In SpA, the prevalence of undiagnosed IBD was 5.7%, higher in axSpA (8.9%) than in PsA (2.4%) patients, with CD being the most common. SpA patients with FC levels < 147 g/g had a very low probability of IBD. 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