Faecal Calprotectin for the Diagnosis of Bowel Inflammation in Patients With Rheumatological Diseases: A Systematic Review

• Published in: Journal of Crohn's and colitis Vol. 14; no. 5; pp. 688 - 693
• Main Authors: Fauny, Marine, D’Amico, Ferdinando, Bonovas, Stefanos, Netter, Patrick, Danese, Silvio, Loeuille, Damien, Peyrin-Biroulet, Laurent
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 19-06-2020; Elsevier - Oxford University Press
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Feces - chemistry; Human health and pathology; Humans; Hépatology and Gastroenterology; Inflammatory Bowel Diseases - complications; Inflammatory Bowel Diseases - diagnosis; Inflammatory Bowel Diseases - metabolism; Inflammatory Bowel Diseases - pathology; Intestinal Mucosa - pathology; Leukocyte L1 Antigen Complex - analysis; Life Sciences; Observational Studies as Topic; Rhumatology and musculoskeletal system; Severity of Illness Index; Spondylitis, Ankylosing - complications; Spondylitis, Ankylosing - drug therapy; Spondylitis, Ankylosing - metabolism; spondyloarthritis; Faecal calprotectin; inflammatory bowel disease; ankylosing spondylitis; Fecal calprotectin
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjz205

Abstract
Background and Aims
Endoscopic and histological gut inflammation are present in half of patients with ankylosing spondylitis [AS] or spondyloarthritis [SpA]. We performed a systematic literature review on the use of faecal calprotectin [FC] in patients with rheumatic diseases.
Methods
Searches of the PubMed, Web of Science, and Cochrane Library databases were performed up to September 2019 to identify all studies including adult patients with confirmed diagnosis of SpA or AS.
Results
Seven studies met the inclusion criteria: six prospective observational studies and one retrospective observational study. Study populations consisted of SpA patients in four studies and AS patients in three studies. In six studies, an ELISA test was used for FC levels and in one case, a semi-quantitative assay was adopted. In all included studies, patients with SpA or AS had elevated FC levels, ranging from 21.2% to 70.7% of patients. In six studies, patients with increased FC levels had macroscopic mucosal inflammation, ranging from 11% to 80% of cases. Four studies highlighted the presence of microscopic alterations in patients with high FC levels, ranging from 41.7% to 100% of patients. An FC cut-off level predicting the inflammatory bowel disease [IBD] occurrence was found in two studies: 266 mg/kg and 132 mg/kg, with sensitivity and specificity of 100%, 78.7% and 66.7%, 76.9%, respectively.
Conclusions
Faecal calprotectin is a useful and non-invasive marker to predict IBD in patients with SpA or AS. Gut histological and macroscopic mucosal inflammation were found in up to 100% and 80% of rheumatological patients with increased FC levels.