AB0699 Enthesitis and Sacroiliitis Prevalence Determined by Doppler Ultrasonography and Magnetic Resonance Imaging in Patients with Inflammatory Bowel Disease

Abstract

BackgroundPatients with inflammatory bowel disease (IBD): Crohn disease (CD) and ulcerative colitis (UC) can develop extraintestinal manifestations and ones of the most important are musculoskeletal affections. In published studies, the prevalence of Spondyloarthritis (SpA) stands from 10 to 20% but with a wide range of variation. These differences are related to the methods used for its determination.Objectives1) To determine the prevalence of sacroiliitis with X-ray or magnetic resonance imaging (MRI) and of enthesitis with Doppler ultrasonography in patients with active IBD without following an immunosuppressant therapy 2) To check the prevalence of patients with positive ASAS criteria for axial and peripheric SpA.MethodsCross-sectional study in which a sample of patients diagnosed of active IBD, without previous diagnosis of rheumatic inflammatory disease and without any previous immunosuppressant therapy, underwent a comprehensive rheumatologic examination addressed to detect musculoskeletal SpA features. Data collected comprised: demographics, family medical history, IBD characteristics and comorbidities, axial symptoms, swollen and tender joint counts (44/46 joints), entheses and dactylitis examinations, BASDAI and BASFI questionnaires and CRP and HLAB27 blood tests. The following image techniques were also applied: cervical, lumbar column and pelvis X-ray, sacroiliac MRI with T1 and STIR sequence and ultra-sound exploration of entheses.Results30 patients (16 women) with a mean age 39.8 (9,8) years have been studied. 16 had CD and 14 UC. 16% tested positive for B27. 14 patients referred chronic lumbar pain, 4 of them with inflammatory characteristics. 10 patients referred arthralgias, without joint swelling o redness and 3 patients had history of heel pain, although they were not explored for any physician. None of the patients did not refer past medical history of uveitis or psoriasis (family or own history). 36% of the patients had MRI signs of sacroiliac inflammation that met ASAS criteria. One of the patients had grade 3 radiographic sacroiliitis and one patient with inflammatory signs in sacroiliac joints by MRI did not refer chronic lumbar pain. Ultrasound alterations were found in at least one enthesis within 97% of the patients: entheses calcifications (72%), bursitis (61%) and erosion (5%).ConclusionsIn patients with active IBD not previously diagnosed with SpA, the existence of sacroiliitis and ultrasound alterations in entheses is frequent (36% and 97%, respectively). The prevalence of patients meeting axial SpA ASAS criteria is 32% and for peripheral criteria is 10%. The lower frequency of peripheral SpA can be attributed to an earlier diagnose of this form of presentation or to a lack of sensitivity of the peripheral SpA ASAS criteria on patients with IBD. Addition of ultrasound results in classification criteria could take into account patients with enthesitic signs earlier.Disclosure of InterestNone declared

Prevalence of axial spondyloarthritis in patients with inflammatory bowel disease using cross-sectional imaging: a systematic literature review

“…In the four studies using MRI, the prevalence of sacroiliitis ranged from 20.0% to 38.6%. 41 , 45 , 50 , 51 The prevalence of sacroiliitis in the four studies using MRE ranged from 15.4% to 28.9%. 39 , 42 , 49 , 53 …”

“…A higher prevalence of sacroiliitis was seen in the studies using dedicated imaging of the SIJs, with four of the six SIJ imaging studies observing this (see Figures 2 and 3 ). 30 , 45 , 47 , 51 All of the studies utilising SIJ CT imaging observed a higher prevalence compared with only half of the studies using SIJ MR imaging. In contrast, only one study using IBD imaging was found to observe a higher prevalence.…”

“…Table 1 illustrates the methodological assessment used and the percentage of studies that scored positive on each item. Of the included studies, 13 were papers and 7 were abstracts 29 , 30 , 38 – 55 (see Table 2 ); 14 studies used CT-sacroiliitis, 4 MRE and 4 axial MRI to determine the prevalence of axSpA in IBD cases, with 2 studies including both CT and MR imaging modalities. 39 , 53 A summary of the cohorts’ demographics and IBD phenotypes are detailed in Table 2 and the IBD features associated with sacroiliitis are summarised in Table 3 .…”

“…The prevalence of sacroiliitis was found to be higher in five of the studies. 30 , 45 , 47 , 49 , 51 x -axis units (0–1) = 0–100% of IBD patients.…”

“…42,50 Two studies found that sacroiliitis was more common in male IBD patients, 40,52 whilst another found it to be more common in female CD patients, although there was no significant difference in the total IBD group. 42 Musculoskeletal symptoms, HLA B27 and sacroiliitis Four studies included IBP assessment prior to recruitment, 29,44,47,49 and six included an IBP assessment following recruitment, 39,41,45,48,50,51 but the forms of assessment varied and were not always stated ( Table 2). Two of the studies found an association between the presence of IBP and sacroiliitis.…”