Spondyloarthritis (SpA) and inflammatory bowel disease (IBD) share pathophysiological mechanisms and often coexist, complicating diagnosis and management. A multidisciplinary approach can optimise care.
MethodsA descriptive, retrospective study analysed the activity of the Rheumatology-Gastroenterology multidisciplinary unit at the Hospital Universitari Parc Taulí between January 2018 and April 2025. Medical records and hospital registries were reviewed.
ResultsA total of 258 patients was seen (62.8% women), with 666 visits in total. Of these, 35.7% were referred from Rheumatology and 64.3% from Gastroenterology. A total of 60 patients (23.3%) were identified with SpA-IBD association, of which 44 were de novo diagnoses (17%): 35 patients were diagnosed with SpA and 9 with IBD. Treatment was modified in 58.3% of these cases. In addition, a training programme was implemented with resident rotations and regular clinical sessions.
ConclusionsThe multidisciplinary model may facilitate early diagnosis and improve the comprehensive management of patients with SpA and IBD, enhancing treatment coordination and specialised training.
Las espondiloartritis (EspA) y la enfermedad inflamatoria intestinal (EII) comparten mecanismos fisiopatológicos y con frecuencia coexisten, complicando el diagnóstico y el manejo. Un abordaje multidisciplinar puede optimizar su atención.
MétodosEstudio descriptivo, retrospectivo, que analizó la actividad de la unidad multidisciplinar Reumatología-Gastroenterología del Hospital Universitari Parc Taulí entre enero de 2018 y abril de 2025. Se revisaron historias clínicas y registros hospitalarios.
ResultadosSe atendieron 258 pacientes (62,8% mujeres), con 666 visitas en total. El 35,7% fueron derivados desde Reumatología y el 64,3% desde Gastroenterología. Se identificaron 60 pacientes (23,3%) con asociación EspA-EII, de los cuales 44 fueron diagnósticos de novo (17%): 35 pacientes fueron diagnosticados de EspA y 9 de EII. El tratamiento se modificó en el 58,3% de estos casos. Además, se implementó un programa formativo con rotación de residentes y sesiones clínicas periódicas.
ConclusionesEl modelo multidisciplinar puede favorecer el diagnóstico precoz y mejorar el manejo integral de pacientes con EspA y EII, facilitando la coordinación terapéutica y la formación especializada.
Spondyloarthritis diseases (SpAs) are a family of related rheumatic conditions that share common clinical features and a genetic basis, enabling them to be recognised and grouped. They include forms that primarily affect the axial skeleton, such as axial spondyloarthritis (AxSpA), and other conditions with a predominance of peripheral symptoms, such as psoriatic arthritis (PsA) and peripheral spondyloarthritis (PaSpA). It is often associated with other immune-mediated diseases that complicate the management of SpA cases: among them, inflammatory bowel disease (IBD), psoriasis and anterior uveitis are common.1
IBD includes ulcerative colitis (UC) and Crohn's disease (CD). Approximately 5%–10% of patients with SpA have associated IBD.2 On the other hand, between 17% and 30% of patients with IBD have arthritis, which is the most prevalent musculoskeletal manifestation.3 However, this prevalence could be underestimated due to underdiagnosis and/or a delay in diagnosis. The diagnostic delay can be up to several years, which leads to poor symptomatic control that affects quality of life and possible progression of the disease due to the lack of adequate treatment.4
A multidisciplinary approach that enables joint evaluation by the rheumatologist and the gastroenterologist could promote early diagnosis and facilitate treatment management.5 In this context, the Parc Taulí University Hospital has been a pioneer in the creation and implementation of the multidisciplinary Rheumatology-Gastroenterology unit for a joint approach to SpA and IBD, adopting a multidisciplinary hospital visit format with a model of joint medical care. The purpose of this study was to describe the experience obtained after 7 years of operation with the multidisciplinary unit.
Material and methodsA descriptive, retrospective study was run, reviewing the care provided at outpatient clinics under the multidisciplinary Rheumatology-Gastroenterology unit, between January 2018 and April 2025.
Data from hospital electronic records and patients’ medical records were used as a source of information.
Human resourcesThe multidisciplinary unit is permanently made up of a gastroenterologist who is an expert in IBD and a rheumatologist specialised in SpA, who both evaluate patients simultaneously. The unit was created by rheumatologist JG together with gastroenterologist XC; and later, the rheumatologist ML and the gastroenterologist AV. Referrals to the unit are made internally from the Gastroenterology (IBD unit) and Rheumatology units. The diagnoses of SpA were clinical diagnoses by the rheumatologist specialised in SpA and the diagnosis of IBD was made by the gastroenterologist expert in IBD and confirmed by imaging test and/or biopsy.
Logistical resourcesA regular schedule of multidisciplinary hospital appointments was set up for every 15 days in the area of the Rheumatology outpatient visits, with the aim of ensuring that patients with IBD-associated SpA received early, comprehensive care from specialists in Rheumatology and Gastroenterology.
The unit has an ultrasound scanner with an 8.0–18.0 MHz linear probe, specifically designed to assess the musculoskeletal system, and a 1.0–8.0 MHz transducer to assess the intestine. This allows, if necessary at the time of the visit, for assessment of joint or IIM activity.
Training planThe unit has systematically rotated residents from the specialties of Rheumatology and Gastroenterology. In addition, since its creation, periodic training sessions have been run for both rheumatologists and gastroenterologists.
ResultsMedical care programmeDuring the period between January 2018 and April 2025, the multidisciplinary Rheumatology-Gastroenterology unit at the Parc Taulí University Hospital treated a total of 258 patients, of whom 162 were women (62.8%) and 96 were men (37.2%). Throughout these 7 years, 666 medical visits were made, with an average of 6 patients per visit per day.
Throughout the period assessed, a progressive increase in the volume of medical visits was observed. The only exception to this trend was recorded in 2020, coinciding with the COVID-19 pandemic, during which face-to-face appointments were temporarily reduced.
A total of 92 patients (35.7%) were referred from the Rheumatology unit, compared to 166 (64.3%) patients referred from Gastroenterology. The main reason for referral by Rheumatology was diarrhoea, as opposed to arthralgias and low back pain in the case of Gastroenterology. Of the patients referred by Rheumatology, 60 had a known diagnosis of AxSpA 30 of PsA and 2 of juvenile idiopathic arthritis (JIA). Of the 166 patients referred by Gastroenterology, 101 patients had a diagnosis of CD and 65 of UC. After joint evaluation in the multidisciplinary unit, a total of 60 patients were identified with a diagnosis of IBD-associated SpA or vice versa, representing 23.3% of the total treated (Fig. 1). Of these, 44 de novo diagnoses were reached (17% of the total attended): 32 patients were diagnosed after the visit to the multidisciplinary SpA unit (24 cases of AxSpA, 8 PaSpA and 3 PsA). Among the patients referred by rheumatology, 9 patients with IBD (8 CD cases and 1 UC) were identified (Fig. 2).
These new identifications have made it possible to intervene early in the evolution of the disease and to adjust treatment management. As a direct consequence of the joint assessment, treatment was changed in 35 patients (58.3%) of the total of 60 patients with both diagnoses.
A total of 60 musculoskeletal ultrasounds were performed. This made it possible to objectively confirm in situ the presence of synovitis and enthesitis in patients with inconclusive joint symptoms, facilitating early diagnosis, improving diagnostic accuracy and optimising treatment decisions. In the last year, intestinal ultrasound has also been added, with a total of 8 examinations being undertaken. Intestinal ultrasound has proven to be a non-invasive method to assess signs of active intestinal inflammation, such as thickening of the wall, changes in vascularisation, or the presence of fibroadipose proliferation. This is also useful for the detection of associated complications, such as abscesses or fistulas. Overall, this technique has proven useful both in the initial diagnosis and for monitoring flare-ups in patients with known IBD.6
Training planThe unit has implemented a structured training programme with the aim of improving the clinical competence of professionals involved in the management of immune-mediated diseases with musculoskeletal and intestinal manifestations. Within the framework of this programme, residents from the specialities of Rheumatology and Gastroenterology have been rotated annually through the unit; one resident from each speciality per year, acquiring cross-functional training and direct exposure to a multidisciplinary and integrated care approach.
Since the creation of the unit, 5 periodic clinical and educational sessions have been organised aimed at both rheumatologists and gastroenterologists at the Parc Taulí University Hospital. The aim of these sessions is to increase awareness and knowledge about immune-mediated chronic inflammatory diseases, with a special focus on the early recognition of extraintestinal and musculoskeletal manifestations, as well as on the timely referral of patients to the multidisciplinary unit.
DiscussionWe present our experience with a multidisciplinary Gastroenterology-Rheumatology unit of the Parc Taulí University Hospital during the period 2018−2025. The accumulated experience of the multidisciplinary unit has made it possible to verify multiple benefits both in the field of care and training. This is a collaborative model in the diagnosis, treatment and follow-up of patients with SpA and IBD, pathologies, which often coexist and share common pathophysiological mechanisms.
The joint assessment by Rheumatology and Gastroenterology has provided earlier and more accurate diagnoses, integrating musculoskeletal and intestinal symptoms in the same consultation. This approach has been especially useful in patients with atypical or overlapping symptoms, where the differential diagnosis can be complex. Likewise, consensus-based decision-making over treatment has allowed for more effective pharmacological management, with rational use of biological or synthetic targeted therapies, reducing fragmentation of medical care, minimising duplication of diagnostic tests and promoting personalised treatment strategies.
The high number of referrals from the Gastroenterology unit highlights the need for better identification of musculoskeletal manifestations in patients with IBD. In this sense, the high rate of new diagnoses of spondyloarthritis (17%) and the identification of cases of SpA-IBD association in 23.3% of the patients treated, reinforce the validity and effectiveness of the multidisciplinary care model.
A differential aspect of this unit has been the incorporation of ultrasound as a tool to support diagnosis and clinical monitoring. Musculoskeletal ultrasound has proven useful in the early detection of synovitis and enthesitis, while intestinal ultrasound has made it possible to assess inflammatory activity and possible complications in patients with IBD in a non-invasive way. The availability of these techniques in multidisciplinary patient visits has enriched clinical assessment and has contributed to more comprehensive, dynamic and early decision-making in both pathologies, improving diagnostic accuracy and optimising treatment decisions.
The project has also had a positive impact on the training of residents. The periodic rotation through the unit has fostered a cross-functional and integrative vision of the management of immune-mediated diseases. The periodic clinical and training sessions have contributed to reinforcing mutual knowledge and improving the diagnostic capacity of the professionals involved and referral to the multidisciplinary unit.
ConclusionThe experience of the seven years that the multidisciplinary Rheumatology-Gastroenterology unit has been in operation at the Parc Taulí University Hospital has demonstrated its usefulness in the early diagnosis and comprehensive management of patients with SpA and IBD. This collaborative model has improved care, has optimised the use of diagnostic and treatment resources, and has contributed significantly to the training of professionals with an integrative vision.
