We appreciate the correspondence by Proft et al regarding our study entitled ‘Irritable bowel syndrome symptoms in axial spondyloarthritis more common than among healthy controls: is it an overlooked comorbidity?’,1 2 and thank Annals of the Rheumatic Diseases for the opportunity to respond. We also acknowledge the major contributions of Proft et al to the field of spondyloarthritis (SpA) research. Regarding our main result, that irritable bowel syndrome (IBS) symptoms are significantly more common among patients with axial SpA without known inflammatory bowel disease (IBD) (n=182) than in healthy controls (n=50), Proft et al point out that the increased prevalence is likely due to other causes than actual clinical IBS (in particular gut inflammation and side effects of non-steroidal anti-inflammatory drug (NSAID) use). In response to this, we would first like to draw attention to the rule-out character of the ROME III criteria used to diagnose IBS, as also brought up by Proft et al . According to these, a clinical IBS diagnosis requires both a typical constellation of gastrointestinal symptoms, as defined by the criteria, and the exclusion of organic causes such as IBD or malignancies. The main finding of our study, that 30% of the axial SpA patients in the well-characterised SPARTAKUS cohort reported IBS symptoms, as opposed to 16% of healthy controls (sex/age-adjusted OR 2.5; p=0.036), refers to self-reported symptoms, as defined by the ROME III criteria, but irrespective of their underlying cause (and hence not per se meeting the exclusion condition). This important distinction—between IBS symptoms and a clinical IBS diagnosis—is made throughout our report. In the second part of our study, we then performed a hypothesis-generating analysis of potential drivers behind the observed IBS symptoms. Similar to Proft et al …

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回应：“关于：中轴型脊柱关节炎的肠易激综合征症状比健康对照组更常见：它是一种被忽视的合并症吗？” 由 Proft 等人撰写。

我们感谢 Proft 等人就我们题为“中轴型脊柱关节炎中的肠易激综合征症状比健康对照组更常见：它是一种被忽视的合并症吗？”1 2 的研究的通信，并感谢风湿病年鉴给予我们回应的机会。我们也承认 Proft 等人对脊柱关节炎 (SpA) 研究领域的主要贡献。Proft 等人指出，关于我们的主要结果，肠易激综合征 (IBS) 症状在没有已知炎症性肠病 (IBD) 的中轴型 SpA 患者 (n=182) 中比在健康对照组 (n=50) 中更为常见。患病率增加可能是由于实际临床 IBS 以外的其他原因（特别是肠道炎症和使用非甾体抗炎药 (NSAID) 的副作用）。对此，我们首先想提请注意用于诊断 IBS 的 ROME III 标准的排除特征，Proft 等人也提出了这一点。根据这些，临床 IBS 诊断既需要标准定义的典型胃肠道症状群，又需要排除器质性原因，如 IBD 或恶性肿瘤。我们研究的主要发现是，在充分表征的 SPARTAKUS 队列中，30% 的轴性 SpA 患者报告了 IBS 症状，而健康对照组的这一比例为 16%（性别/年龄调整后的 OR 2.5；p=0.036），指的是自我报告的症状，由 ROME III 标准定义，但不考虑其根本原因（因此本身不符合排除条件）。IBS 症状和临床 IBS 诊断之间的这一重要区别在我们的报告中贯穿始终。在我们研究的第二部分，我们随后对观察到的 IBS 症状背后的潜在驱动因素进行了假设生成分析。类似于 Proft 等人……