Hidden musculoskeletal involvement in inflammatory bowel disease: a multicenter ultrasound study

Abstract

BackgroundInflammatory bowel diseases are associated with a variety of extra-intestinal manifestations. The most frequent of these is joint involvement, which affects 16–33 % of IBD patients. Our aim was to evaluate the ultrasound prevalence of sub-clinical joint and entheseal involvement in patients with IBD without musculoskeletal symptoms, and to correlate the US findings with clinical and laboratory variables.MethodsWe recorded the clinical and laboratory data of 76 patients with IBD, 20 patients with spondyloarthritis (SpA) and 45 healthy controls at three rheumatology centers. All of the IBD patients and healthy controls were clinically examined by a rheumatologist in order to confirm the absence of musculoskeletal symptoms, and all of the subjects underwent grey-scale (GS) and power Doppler (PD) US examinations of the second and third metacarpophalangeal joints, knees and lower limbs in order to detect joint or entheseal abnormalities.ResultsA total of 1410 entheseal sites and 1410 joints were evaluated by US. Of the 76 patients with IBD, 64 (84.1 %) had at least one GS entheseal abnormality, and 11 (13.9 %) had more than one PD-positive entheseal site; 32 (42.1 %) showed sub-clinical joint involvement.There was a significant difference between the IBD patients and healthy controls in terms of global entheseal, PD-positive entheseal, and joint involvement (p < 0.0001), but no difference between the IBD and SpA patients. Anti-neutrophil cytoplasmic antibodies predicted entheseal involvement in patients with IBD (OR 6.031; p = 0.015).ConclusionsThe prevalence of sub-clinical joint and entheseal involvement was higher in IBD patients than healthy controls, but there was no difference between the IBD and SpA patients.

Performance of Two Screening Questionnaires for Inflammatory Arthritis in Patients with Inflammatory Bowel Disease

“…On the other hand, the association between our US findings and the clinical questionnaire responses was weak or nonexistent. In other studies of musculoskeletal US performed in subjects with IBD, a high prevalence of subclinical US abnormalities has been found [ 17 , 18 ]. Something similar has been published in patients with psoriasis without arthritis [ 19 ].…”

Enthesitis: an obscured extraintestinal manifestation in pediatric inflammatory bowel disease

“…This was similar to adult IBD studies in which both physical and US examinations had been performed and the frequencies had been reported to be between 44.3-84.1%. 34,35 In a meta-analysis performed for the prevalence of the axial and peripheral manifestation in adults with CD and UC, the prevalence of the peripheral manifestations such as enthesitis was reported to range between 1-54%. 36 Jousse-Joulin et al 5 found that entheseal tenderness does not always correspond to ultrasound abnormalities while radiographic enthesitis is also not associated with positive physical examination findings, suggesting subclinical enthesitis.…”

Imaging in the Assessment of Musculoskeletal Manifestations Associated with Inflammatory Bowel Disease

“…An Italian cross-sectional study involving 81 IBD patients without musculoskeletal symptoms revealed gray-scale lower limb entheseal alterations in 71 (92.6%) cases and a positive power Doppler in 13 (16%) [43]. A multicenter cross-sectional study of IBDs 76 patients highlighted that 64 (84.1%) had at least one grayscale entheseal alteration, 11 (13.9%) one entheseal positive power Doppler, and 32 (42.1%) sub-clinical joint involvement [44]. A Turkish monocentric cross-sectional study including 43 IBDs, 44 celiac patients and 18 healthy controls found higher entheseal gray-scale and power Doppler US alterations in the two pathological groups [45].…”