4/15/2024
According to a study published in Rheumatic & Musculoskeletal Diseases Open, there is a high prevalence of Irritable Bowel Syndrome (IBS) in individuals with axial spondyloarthritis (axSpA), and having IBS is strongly associated with anxiety and physical inactivity.
The study consisted of two parts. In the first part, researchers collected data from axSpA patients who were undergoing biologic treatments. They used a specific set of criteria called Rome IV to assess the presence of IBS symptoms. The second part of the study involved analyzing existing research on IBS in patients with spondyloarthritis (SpA) and examining the characteristics of SpA patients with and without IBS. Various types of studies, including randomized controlled trials, observational studies, and case/control studies, were included in the analysis.
Out of the 500 patients with axSpA included in the first part of the study, 124 of them reported symptoms of Irritable Bowel Syndrome (IBS), which accounts for 25% of the total. Several factors were found to be associated with IBS symptoms, including being female, being unemployed, having higher scores on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and worse scores on the Bath Ankylosing Spondylitis Functional Index, receiving multiple lines of biologic treatments, having fibromyalgia, experiencing anxiety and depression, and having lower levels of physical activity. When considering multiple factors together, the risk of developing IBS was found to be associated with anxiety and physical inactivity.
The literature review conducted as the second part of the study revealed that the prevalence of IBS in patients with axSpA was approximately 15.4%, with a range of 8.8% to 23.3%. A meta-analysis of five studies comparing the presence of IBS in patients with SpA (323 out of 7,292) and healthy controls (484 out of 35,587) showed a significant increase in the occurrence of IBS among patients with SpA.
This study has some limitations. It only looked at a specific group of patients with axSpA who were treated with biologics, so the findings may not apply to all people with SpA. The study design didn’t allow for long-term follow-up of patients’ diet and physical activity. In addition, some of the information collected was based on what patients reported, which may not always be completely accurate. For diagnosing IBS, there were limitations like not having enough information about excluding other diseases or doing colonoscopies.
The researchers assert that nonetheless, the study demonstrates the importance of considering IBS as a diagnosis, for axSpA patients with gastrointestinal symptoms, particularly those who also have anxiety and low physical activity. In addition, since the study suggests that patients with IBS often have additional conditions such as fibromyalgia, unemployment, higher disease activity, and poorer functional scores, these factors can help identify people who have difficult-to-manage cases of axSpA. These factors can make managing the disease more challenging.
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