Microvascular impairments in axial spondyloarthritis associated with Crohn’s disease

Introduction. Spondyloarthritis (SpA) associated with inflammatory bowel disease (IBD) is a disease in the SpA group developing in patients with Crohn’s disease (CD) and ulcerative colitis. Gut-vascular barrier impairments, including increased epithelial permeability and endothelial glycocalyx (EGc) damage, have been demonstrated in both CD and axial SpA (axSpA), and can serve as a pathogenetic basis for the joint development and progression of these diseases.

Aim. To evaluate the significance of EGc damage and epithelial permeability markers in patients with CD-associated axSpA.

Materials and methods. We examined 22 patients with axSpA associated with CD (group A), 29 patients with axSpA without IBD (group B), 27 patients with CD (group C) and 28 conditionally healthy controls (group D). Calprotectin (FC) and zonulin (FZ) in feces, hyaluronan and syndecan 1 in serum were studied. Perfusion boundary region (PBR) and the Microvascular Health Index (MVHS) were measured by dark-field microscopy in the sublingual region.

Results. In patients with CD-associated axSpA, an increase in PBR (p<0.001) and a decrease in MVHS (p=0.001) were revealed in comparison with healthy individuals. Only CD patients revealed decreased serum hyaluronan (p=0.006) associated with colitis and deep ulcers on endoscopy. Increased PBR allowed to identify very high axSpA activity in group A with a sensitivity of 100 % and specificity of 83.3 %. In group A patients, a correlation between hyaluronan and FC was found (ρ=–0.541; p=0.030). A classification tree, including FC, FZ, hyaluronan, and MVHS, was constructed to determine the presence of CD in axSpA patients with an accuracy of 90.2 %.

Conclusions. The study of the gut-vascular barrier damage markers allows to improve the methods of diagnosis and assessment of the integral activity of axSpA associated with CD.

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