Increased gut inflammation is associated with greater structural spinal damage in axial spondyloarthritis

1. Increased gut inflammation, as measured by fecal calprotectin, is significantly associated with greater structural spinal damage in axial spondyloarthritis

Evidence Rating Level: 2 (Good)

A significant proportion of patients with axSpA have comorbid inflammatory bowel disease (IBD) or elevated inflammation, measured histologically and through fecal calprotectin. Prior studies have identified a link between the degree of inflammation and more active disease in axSpA. However, it is unknown whether gut inflammation is also associated with more structural spinal damage in axSpA. This cross-sectional analysis of the SPARTAKUS cohort analyzed 228 patients (mean age ± SD, 51.0 ± 13.0; 53% male) with well-established non-radiographic or radiographic axSpA. axSpA Patients were stratified by fecal calprotectin levels (< 50 mg/kg, 50-149 mg/kg, and ≥ 150 mg/kg). There was significantly higher structural spinal damage, measured with the modified Stoke ankylosing spondylitis spinal score (mSASSS) in the fecal calprotectin > 50 mg/kg group compared to the fecal calprotectin < 50 mg/kg group (OR 95% CI, 2.17 (1.24-3.80), p = 0.007). This relationship remained after removing IBD patients from analysis (OR 95% CI, 2.48 (1.36-4.53), p = 0.003). Overall, this study suggests the degree of gut inflammation is a good prognostic indicator of spinal radiographic progression in axSpA. However, prospective studies are required to elucidate causality.

Click here to read this study in Arthritis Research & Therapy

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