S1146 Inflammatory Bowel Disease (IBD)-Associated Peripheral Arthritis is Not Associated With Objective Markers of Luminal IBD Disease Activity - Results From the CHASE Cohort
Bibliographic record
Abstract
Introduction: Inflammatory bowel disease (IBD)-associated peripheral spondyloarthritis (IBD-pSpA) is common but remains understudied. Although the type I vs type II classification, which categorizes patients based upon number and size of involved joints, is commonly accepted by gastroenterologists, this schema is neither widely accepted within the rheumatology literature nor prospectively validated. The aim of this study was to assess the association between clinical presentation of IBD-pSpA and IBD activity. Methods: We prospectively recruited patients with IBD-pSpA, defined by previously established consensus criteria (incorporating presence of swollen/tender joints on physical exam), from 6 sites across the United States. The relationship of clinical presentation of IBD-pSpA (number and type of involved peripheral joints as proposed by the type I vs type II classification schema) with objective markers of disease activity was assessed. Unadjusted univariate logistic regression analysis was performed to assess association between joint distribution and disease activity. R software was used. A significance level of 0.05 was assumed for all tests. Results: One hundred 6 patients (61% female, 70% Crohn’s disease (CD)) were included (see Table 1 for summary statistics). Within a month of enrollment, 24% had results available for fecal calprotectin and 53% for C-reactive protein (CRP). Within 3 months of enrollment, 18% had IBD-related imaging. The most recent endoscopy results were available in 96% of patients, with median time from endoscopy to enrollment 0.8 years (interquartile range 0.3-1.60). There was no statistically significant association between pattern of joint distribution and elevated fecal calprotectin ( >150 μg/g), active IBD on imaging, or active CD endoscopically. There was a statistically significant association between knee involvement and elevated CRP (odds ratio [OR], 4.3; 95% CI, 1.18–21.0; P =0.04) and active ulcerative colitis (UC) endoscopically (OR, 5.9; 95% CI, 1.16– 37.0; P =0.04). Conclusion: Contrary to the type I vs type II classification, in this prospective study, the pattern of joint involvement in IBD-pSpA was not associated with IBD activity. Knee involvement was associated with elevated CRP and endoscopic activity in patients with UC. Table 1. - Summary Descriptive Statistics Variable All Age at Enrollment, Median [25th 75th] 46.7 [31.8; 56.9] Sex, N (%) Male Female 65 (61.3) IBD Diagnosis, N (%) Ulcerative Colitis 31 (29.5) Crohn’s Disease 74 (70.5) Patient Report of Joint Pain, N (%) 105 (99.1) Patient report of Joint Stiffness, N (%) 82 (79.6) Number of Tender/Swollen Joints, N (%) < 5 joints 51 (49.5) >=5 joints 52 (50.5) Location of Joints Hand(s) 72 (67.9) Elbow(s) 21 (19.8) Shoulder(s) 27 (25.5) Hips(s) 29 (27.4) Knee(s) 56 (52.8) Ankles(s) 18 (17.0) Foot/Feet 27 (25.5) Current Medications, N (%) Prednisone 17 (16) Budesonide 1 (0.9) Balsalazide 1 (0.9) Mesalamine 6 (5.7) Sulfasalazine 8 (7.6) Azathioprine 5 (4.7) 6-Mercaptopurine 4 (3.8) Methotrexate (oral) 12 (11.3) Methotrexate (subcutaneous) 4 (3.77) Infliximab / Biosimilar 16 (15.1) Adalimumab / Biosimilar 8 (7.6) Golimumab 1 (0.9) Certolizumab 3 (2.8) Vedolizumab 22 (20.8) Ustekinumab 21 (19.8) Upadacitinib 7 (6.6) Risankizumab 6 (5.7) Objective Assessment of IBD Disease Activity Fecal calprotectin Total: 25 (24.3)Elevated 10 (40) CRP Total: 56 (53.3)Elevated: 16 (28.6) Imaging Total: 18 (18.2)Active: 11 (61.1) Endoscopy Total 101 (96.2), CD: 73 (73), UC: 27 (27)Active UC: 13 (48.1)Active CD: 32 (43.8) Caption: IBD = inflammatory bowel disease, CRP = C reactive protein.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".