P0263Enhancing early diagnosis and differential assessment of Inflammatory Bowel Disease-related spondylarthritis through a multidisciplinary strategy: findings from a cross-sectional Study

Background Spondyloarthritis (SpA) represents the most common extraintestinal manifestation observed in patients with Inflammatory Bowel Disease (IBD), with an estimated prevalence of approximately 15%. SpA, encompasses a group of disorders —including radiographic ankylosing spondylitis, psoriatic arthritis, reactive arthritis, non-radiographic axial SpA, undifferentiated SpA, and IBD-associated SpA—characterized by similar clinical, radiological and genetic features. The similarities between SpA and other non-SpA spondyloarthropaties often complicates differential diagnosis. In this context, multidisciplinary collaboration can facilitate accurate classification and early diagnosis, enabling timely intervention and preventing long-term structural damage. This cross-sectional study evalutes the impact of a collaborative multidisciplinary approach between gastroenterologist and rheumatologist on the early diagnosis of IBD-related spondylarthritis (IBD-SpA) and its differentiation from other musculoskeletal manifestations. Methods This is cross-sectional study in which IBD out-patients were evaluated simultaneously by a gastroenterologist and a rheumatologist. Patients underwent a comprehensive rheumatologic assessment, the DETAIL questionnaire and laboratory and imaging investigations if indicated. The suspected cases were classified as newly diagnosed IBD-SpA, alternative diagnoses, or nonspecific arthralgias. Results A total of 605 IBD patients were screened for IBD-spA (Table 1). Among them, 81 (13%) had a known diagnosis of SpA, and 117 (19.3%) were suspected of having IBD-SpA. Upon further assessment, SpA was confirmed in 18 (15%) suspected cases, yielding a 22% relative increase in SpA prevalence. mostly identified within the first year of symptom onset (44% of cases). A longer diagnostic delay was observed in patients with axial vs peripheral involvement (mean ±SD 12.4 ± 10.2 vs 2.9 ± 2.9, p = 0.035). SpA was excluded in 85% of suspected cases, which were ultimately diagnoses as other arthropaties (60%) or non-specific arthralgias (25%). Figure 1. Swollen joint count was the only predictor of SpA diagnosis (adjOR 5.70, 95%CI 2.18-1.61, p < 0.001). Finally, while 67% of patients with suspected SpA reported back pain, only 18% met ASAS criteria for inflammatory back pain. Magnetic Risonance Imaging was performed in all patients with IBP, showing evidence of sacroiliitis and/or spondylitis in 24% of cases. Conclusion A multidisciplinary approach significantly enhances the early and accurate identification of IBD-SpA. This strategy improves diagnostic accuracy, facilitating timely intervention and tailored management for affected patients. References: 1. Karreman MC, Luime JJ, Hazes JMW, et al. The prevalence and incidence of axial and peripheral spondyloarthritis in inflammatory bowel disease: asystematic review and Meta-analysis. J Crohn Colitis 2017;11:631-42. 2. Dougados M, Baeten D Spondyloarthritis. Lancet 2011;377:2127–37. 3. Mitsuhiro Akiyama, Waleed Alshehri, Koji Suzuki, Kanako Shimanuki, Koichi Saito, Yuko Kaneko,Clinical features, pathogenesis, and treatment of inflammatory bowel disease-associated spondyloarthritis, Autoimmunity Reviews, Volume 24, Issue 9, 2025, 103853. Conflict of interest: Piras, Raffaela: No conflict of interest Floris, Alberto: No conflict of interest Dr. Favale, Agnese: Advisory Board for AbbVie Sichi, Leonardo: No conflict of interest Falconi, Marcella: No conflict of interest Olla, Federica: No conflict of interest Pace, Andrea: No conflict of interest Onnis, Francesca: No conflict of interest Angioni, Maria Maddalena: No conflict of interest Italia, Angelo: No conflict of interest Fantini, Massimo Claudio: MCF has acted as a consultant for: AbbVie, AlfaSigma, Celgene, Celltrion, Gilead, Pfizer, MSD, Bristol-Meyer, Takeda, Johnson & Johnson, Roche, Galapagos, Biogen, Sandoz, Eli-Lilly, Lionhealth, Teva, Giuliani, Dr Falk Pharma, Sanofi he has received financial support for research from Johnson & Johnson and Pfizer. Cauli, Alberto: No conflict of interest Onali, Sara: Consultant/lecture fees to: Abbvie, Alfasigma, MSD, Takeda, J & J, Galapagos, Pfizer, Eli Lilly