Does Having IBD Worsen Disease Activity or Progression of AxSpA?

October 16, 2025

According to a study published in Rheumatology, having inflammatory bowel disease (IBD) does not appear to worsen disease activity or speed up spinal damage in people with axial spondyloarthritis (axSpA).

Because IBD and axSpA share overlapping immune pathways and often occur together, researchers have long wondered whether one condition might intensify the other. To explore this, investigators followed 1,451 people living with axSpA at a major medical center. Of these, about 13% also had IBD, such as Crohn’s disease or ulcerative colitis.

The study found that those with both axSpA and IBD had some differences in their clinical profiles: they were less likely to carry the HLA-B27 gene and more likely to experience eye inflammation (uveitis), peripheral joint pain, and elevated inflammation markers.

Even so, when it came to overall disease activity and long-term outcomes, there was no evidence that having IBD made axSpA worse. Patients with both conditions were no more likely to have active disease or to show greater spinal damage on X-rays over two years than those with axSpA alone.

Researchers concluded that while the two diseases share common biological mechanisms, IBD does not appear to drive more severe axSpA. They note, however, that future research should look at whether the severity or duration of IBD might influence long-term outcomes.

References:

• Rheumatology – Inflammatory bowel disease does not confer higher disease activity or greater radiographic progression in axial spondyloarthritis
• Spondylitis Association of America – People with IBD Face Greater Risk of Spondyloarthritis, Study Suggests
• Spondylitis Association of America – IBS Prevalent in People with axSpA; IBS Also Linked to Anxiety and Physical Inactivity