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Background It is estimated that between 5% and 10% of patients with spondyloarthritis (SpA) are associated with inflammatory bowel disease (IBD). It has also been proven through endoscopic and histological studies that up to 60% of patients with SpA have microscopic inflammatory intestinal lesions, with a subclinical character and of which the true clinical relevance is unknown, although a greater percentage of these are those that will evolve to IBD. Objectives To assess whether tobacco use may be associated with higher faecal calprotectin (FC) levels in patients with diagnosis of SpA and without clinical suspicion or previous diagnosis of IBD. Methods TThis is a single centre, cross-sectional, observational study with prospective collecting data. Data were included for consecutive patients from Rheumatology consultation who had been previously diagnosed of SpA, fulfilled ASAS criteria and without digestive symptoms suggestive of IBD (chronic diarrhoea, rectal bleeding, perianal disease, chronic abdominal pain – persistent or recurrent). Details about demographic characteristics, clinical and laboratory variables related with SpA (BASDAI, HLA B27, acute phase reactants), treatments and FC were collected. A pathological cut-off point of FC>50 mg/kg was determined. Patients on NSAIDs treatment were advised to discontinue its use 2 weeks before collecting stool samples. This study was approved by the Clinical Research Ethics Committee. Results 99 patients were included: 53.5% women, with a mean age of 46±11 years. nonspecific digestive disorders (dyspeptic symptoms, H. pylori y gastroesophageal reflux) were observed in 9% of the patients. Among all, 18% were smokers. Mean BASDAI was 3.7±2.5; 39% of patients were being treated with any concomitant DMARD and 67% were on NSAIDs. 49.5% of the patients49 showed elevated FC determinations, with an mean level of 276 mg/kg (range 52–3,038). The percentage of patients with high levels of FC was significantly increased in smokers (72.2% vs. 44.4%, p. 0.033), with higher levels of FC in smokers than non-smokers (262 mg/L vs. 121 mg/L. p. 0.126). The remaining analysed variables did not show any significant differences in terms of FC levels. Conclusions Microscopic bowel inflammation is described in approximately 50% of patients with SpA and it is related with more severe disease. Tobacco use has been associated with worse prognosis and response to treatment in SpA. A relationship between elevated FC levels (inflammatory activity biomarker) and tobacco use in patients with SpA without previous diagnosis or clinical suspicion of IBD is established in this study. Disclosure of Interest None declared |
