Peripheral arthropathy among patients with inflammatory bowel disease in Sulaimani

Abstract

Background: Arthropathies are a major clinical problem in patients with inflammatory bowel disease (IBD). Often it is difficult to control the articular symptoms with the anti-inflammatory strategies used for IBD. Recently, interest in the multidisciplinary approach to patients with IBD and arthropathy has been increasing, early recognition and proper management of arthropathy is mandatory. Objectives: To find out the frequency of peripheral arthropathy and pattern of joint involvement in inflammatory bowel diseases. Patients and Methods: Forty-eight patients with a definite diagnosis of inflammatory bowel disease (IBD) (41 ulcerative colitis and 7 crohn's disease) have been assessed for peripheral joint involvement and enthesopathy. Patients clinically assessed for bowel conditions, peripheral arthritis, enthesitis and pattern of joint involvement (monoarticular, pauciarticular or polyarticular). Blood test for full blood count, ESR, CRP, RF, Serum electrolytes and serum albumin done for the assessment of disease activity. Radiological assessment of the symptomatic peripheral joints was done by conventional x-ray. Results: Five (10.4%) cases had peripheral arthritis, 4(80%) were pauciarticular, arthralgia and enthesopathy accounted in 10(20.8%) and 2(4.2%) cases respectively. Peripheral arthritis was more among female patients 4(21.05%) with P-value (0.051). All patients with peripheral arthritis were in active state of inflammatory bowel disease. Patients with ulcerative colitis who had extensive colonic involvement were more likely to develop peripheral arthritis with frequency of 2(50%) for left side colitis, 1(25%) for extensive colitis and 1(25%) for pan colitis, While crohn's disease with colonic localization was more likely to develop peripheral arthritis 1(100%) for ileocolitis. Conclusion:The commonest musculoskeletal manifestations of IBD were arthralgia, followed by arthritis and the least was enthesopathy. The most common pattern of peripheral arthritis was pauciarticular and mostly involved the lower limb joints. It was more common in female patients and occurred independent to the duration of inflammatory bowel disease. Keywords: peripheral arthritis (PA), chronic inflammatory bowel diseases (IBD).