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The DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire: development and preliminary testing of a new tool to screen patients with inflammatory bowel disease for the presence of spondyloarthritis

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Abstract

To develop and to test in a preliminary way a new self-administered screening tool, called DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire, in patients suffering from inflammatory bowel disease (IBD) not previously diagnosed as having a spondyloarthritis (SpA). DETAIL questionnaire was realized through the interrogation of 95 experts. They were asked to rate the importance of a list of items, derived from a review of the referral models of SpA, to detect the SpA manifestations in IBD patients. The six top-rated items composed the questionnaire, tested in IBD patients not already diagnosed having a SpA. One-hundred and twenty-eight patients were tested with the DETAIL questionnaire in the gastroenterology setting. After the rheumatologic assessment, in 21 (16.4%) subjects was diagnosed a SpA according to the Assessment of SpondyloArthritis international Society (ASAS) classification criteria. Of the six items of the DETAIL questionnaire, the best positive likelihood ratio (LR+) was found in item 2 (LR+ 3.82), exploring dactylitis, and in item 6 (LR+ 3.82) and item 5 (LR+ 3.40), two questions exploring inflammatory low back pain. Enthesitis (item 3—LR+ 2.87) and peripheral synovitis (item 1 – LR+ 2.81) gave similar results, while item 4, exploring the duration of low back pain, resulted in the worst performance (LR+ 1.99). Three of the six items answered in affirmative way gave a post-test probability ≥ 75%. The presence of a fibromyalgia represents a major confounder. The DETAIL questionnaire showed good screening properties that need to be confirmed in broader cohorts.

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Acknowledgements

We are grateful to all the italian colleagues who participated to this study: Bendia E, Ancona; Bolognini L, Ancona; Bruzzese V, Roma; Chimenti MS, Roma; Clementi C, Roma; Conigliaro P, Roma; Di Sario A, Ancona; Faggioli P, Legnano; Fava G, Ancona; Hassan C, Roma; Laganà B, Roma; Lorenzetti R, Roma; Martin Martin LS, Albano Laziale; Paroli M, Latina; Pica R, Roma; Picchianti Diamanti A, Roma; Pugliese D, Roma; Ribaldone DG, Torino; Rinaldi T, Latina; Santo L, Barletta; Santoboni G, Viterbo; Scolieri P, Roma; Scarpato S, Salerno; Scribano ML, Roma; Serra F, Roma; and Zullo A, Roma.

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Authors and Affiliations

  1. Rheumatological Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Via Aldo Moro, 25, Jesi, 60035, Ancona, Italy

    Marco Di Carlo, Eleonora Di Donato, Walter Grassi & Fausto Salaffi

  2. Medical Clinic, Università Politecnica delle Marche, Ancona, Italy

    Michele Maria Luchetti, Devis Benfaremo & Armando Gabrielli

  3. Digestive System Diseases, Endoscopy and Inflammatory Bowel Diseases Unit, Ospedali Riuniti, Ancona, Italy

    Piergiorgio Mosca

  4. Gastroenterology Unit, “Principe di Piemonte” Hospital, Senigallia, Ancona, Italy

    Stefania Maltoni

  5. Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche, Ancona, Italy

    Antonio Benedetti

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  1. Marco Di Carlo
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  2. Michele Maria Luchetti
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Correspondence to Marco Di Carlo.

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Di Carlo, M., Luchetti, M.M., Benfaremo, D. et al. The DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire: development and preliminary testing of a new tool to screen patients with inflammatory bowel disease for the presence of spondyloarthritis. Clin Rheumatol 37, 1037–1044 (2018). https://doi.org/10.1007/s10067-017-3937-6

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