Diagnosis of Inflammatory Bowel Disease Associated Peripheral Arthritis: A Systematic Review

Introduction: Inflammatory bowel disease (IBD) associated peripheral spondyloarthritis (pSpA) negatively affects quality of life and remains poorly understood. Consequently, evidence-based disease definitions, diagnostic strategies and treatment algorithms are lacking. This systematic review aimed to summarize current approaches to diagnosis of IBD associated pSpA to facilitate the development and validation of patient reported outcomes and imaging indices specific to this condition. Methods: A literature search was conducted in collaboration with a medical librarian. Consensus or classification criteria, case series, cross sectional and cohort studies as well as randomized controlled trials related to diagnosis of IBD associated pSpA were included. Studies that incorporated patient data were required to meet additional inclusion criteria, including a confirmed diagnosis of IBD along with clinical or subclinical IBD associated pSpA. Results: A total of 40 studies were eligible for analysis. Ten studies proposed or validated screening tools, classification criteria, or consensus criteria. The majority of studies incorporated patient report of symptoms along with a physical exam. Symptoms included pain, swelling, morning stiffness and limitations in performing physical activities, while physical examination most commonly comprised evaluation by a rheumatologist for swollen/tender joints or entheses. A total of 27 studies assessed the role of laboratory tests (human leukocyte antigen-B27, erythrocyte sedimentation rate, C-reactive protein) with no marker considered accurate enough to be used as a diagnostic tool. A subset of 14 studies assessed the role of imaging. The currently available data do not support imaging assessment as a robust diagnostic modality, but overall studies were insufficient to fully evaluate this issue. Due to the large heterogeneity in the available data a meta-analysis was not considered feasible. Conclusion: This systematic review indicates a lack of consistency in approaches to diagnosis of IBD associated pSpA. Until an evidence-based approach is established, the incorporation of classification criteria, Delphi consensus criteria, and physician assessment with a high index of suspicion for joint involvement in IBD should be utilized. We intend to pursue a multi-disciplinary approach to standardization of evaluation and diagnosis of IBD associated pSpA.