A study published in the December issue of 'Clinical & Experimental Immunology' elucidated that many major and minor red flags have been recognised for the diagnosis of co-existing IBD-SpA. These can be closely monitored to enhance the clinical management of patients with a suspected connection of inflammatory bowel disease (IBD) and spondyloarthritis (SpA). The collaboration between gastroenterologists and rheumatologists has been suggested for the correct management of patients with associated SpA and IBD.

Felice C et al. focused on establishing the appropriateness of several red flags for a prompt specialist referral. A systematic review of the literature conducted through the GRADE method to describe the prevalence of co-existing IBD-SpA and diagnostic accuracy of red flags suggested by a steering committee. Then, the RAND method was used to obtain a consensus among expert gastroenterologists and rheumatologists (10 in the steering committee and 13 in the expert panel). This helped to confirm the appropriateness of each red flag as 'major' (one sufficient for patient referral) or 'minor' (at least three for patient referral) criteria for specialist referral. The review of the literature revealed the high prevalence of co-existing IBD-SpA. Due to the lack of available data, the positive and negative predictive values of red flags were not calculated. A consensus among gastroenterology and rheumatology specialists was used to confirm the suitability of each red flag. Chronic abdominal pain, rectal bleeding, perianal fistula or abscess, chronic diarrhoea and nocturnal symptoms were the main criteria to refer patients with SpA to the gastroenterologist. Dactylitis, chronic low back pain, enthesitis and pain/swelling of peripheral joints were the main criteria to refer patients with IBD to the rheumatologist.

"The use of red flags in routine clinical practice may avoid diagnostic delay and lessen the clinic overload. Prospective validation of these red flags is crucial before their routine use in clinical practice", as the authors culminated.