Axial Pain and Arthritis in Diagnosed Inflammatory Bowel Disease: US National Health and Nutrition Examination Survey Data

Michael H Weisman; Oleg Stens; Hyun-Seok Kim; Jason K Hou; Frederick W Miller; Charles F Dillon

doi:10.1016/j.mayocpiqo.2022.04.007

Axial Pain and Arthritis in Diagnosed Inflammatory Bowel Disease: US National Health and Nutrition Examination Survey Data

Mayo Clin Proc Innov Qual Outcomes. 2022 Sep 16;6(5):443-449. doi: 10.1016/j.mayocpiqo.2022.04.007. eCollection 2022 Oct.

Authors

Michael H Weisman¹, Oleg Stens², Hyun-Seok Kim³, Jason K Hou^{4

5}, Frederick W Miller⁶, Charles F Dillon⁶

Affiliations

¹ School of Medicine, Stanford University Medical Center, Palo Alto, CA.
² UCSD School of Medicine, San Diego, CA.
³ Department of Medicine, Baylor College of Medicine, Houston, TX.
⁴ Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.
⁵ Department of Medicine, Section of Gastroenterology, Baylor College of Medicine, Houston, TX.
⁶ National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD.

Abstract

Objective: To estimate the nationally representative prevalence of chronic axial pain, inflammatory back pain (IBP), axial spondyloarthritis (axSpA), and peripheral arthritis in persons diagnosed with inflammatory bowel disease (IBD).

Patients and methods: US National Health and Nutrition Examination Survey (NHANES) data from the 1976-1980 and 2009-2010 survey cycles.

Results: In NHANES 1976-1980, the chronic axial pain prevalence in participants with diagnosed ulcerative colitis (UC) was 19.5% vs 7.2% in the general population (P<.01). Neck or upper back, lower back, and Amor criteria-based axial pain were also significantly increased (11.2%, 14.5%, and 13.0%, respectively, vs 3%-5% in the general population (P<.01). In those with diagnosed UC, 40% had axial pain onset at an age older than 45 years; 30.2% reported peripheral arthralgias, and 12.2% reported peripheral arthritis. Arthritis findings on examination were uncommon. In NHANES 2009-2010, axial pain in those diagnosed with IBD had similar patterns.

Conclusion: Despite high rates of chronic axial pain in those with IBD, few cases met the IBP and axSpA classification criteria. This apparent discrepancy is unexplained. However, in IBD, axial pain onset at an age older than 45 years is common; and these may not meet IBP and axSpA age criteria. Also, neck pain was increased in those with IBD but is not included in most IBP and axSpA criteria. Peripheral arthralgias and chronic arthritis symptoms were common, but examination findings were not, suggesting that tenosynovitis or enthesitis is more likely than frank arthritis to occur in patients with UC.

Keywords: AS, ankylosing spondylitis; ESSG, European Spondyloarthropathy Study Group; IBD, inflammatory bowel disease; IBP, inflammatory back pain; NHANES, US National Health and Nutrition Examination Survey; UC, ulcerative colitis; axSpA, axial spondyloarthritis.