Background Enthesis is defined as the insertion point of tendons, fascia or joint capsules into bones. This structure is typically affected by inflammatory rheumatic diseases (IRD), such as spondyloarthritis (SpA) .Now-a-days, limited data on ultrasonographic pattern in patients with enteropathic SA are available .
Objectives To evaluate, using a high frequency ultrasound probe, entheseal involvement in patients with inflammatory bowel disease (IBD) with and without spondiloarthritis (SpA), treated with anti-TNF drugs and clinically in remission.
Methods 15 IBD patients [9 Crohn’s disease (CD) and 6 ulcerative colitis (UC); 8 females and 7 males with a mean age of 42 years (ranging from 26 to 72 years)] with low disease activity or in clinical remission were investigated with US (ESAOTE MyLAB 70 10-18 MHz linear array transducer) and compared with 16 patients with a previous diagnosis of IBD+ SpA [11 CD and 5 UC; 4 females and 12 males, with a mean age of 46.5 years (ranging from 26 to 71 years)]. Brachial triceps, femoral quadriceps, Achilleon, plantar fascia, and proximal and distal patellar entheses were all scored according to the 0-136 Madrid Sonographic enthesis index (MASEI). Correlation between MASEI and IBD variables was also evaluated.
Results The clinical characteristics of IBD and IBD+SpA groups were similar for the following parameters: age (42.13±14.6 vs. 48.00±11.9; p=0.228); sex (p=0.149); BASDAI values (2.70 vs. 3.05; p=0.81); IBD activity (stools number/day: 2.00 vs. 1.75/day; p=0.794), BASFI (1.00 vs. 1.85; p=0.043); disease duration of IBD (7.93±5.4 years vs. 14.19±9.8 years; p=0.048); fingers to floor distance (11.00 cm vs. 33.00 cm; p=0.006). However, morning stiffness (0.00 min vs. 16.00 min; p=0.01) was higher in the IBD+SpA group compared with the IBD group. The median value of the MASEI score was significantly lower in IBD patients compared with IBD+SpA (14 vs 27; p=0.004) but the percentage of patients with MASEI score positive (>18) wasn’t statistically different (33.3% vs 68.8%, Fisher’s test, p=0,056). Moreover, the percentage of patients with at least one power Doppler (PD) positive enthesis (47% vs. 69%; p=0.0285) and enthesophytes (93% vs. 100%), was not statistically different. We found a significant difference between the two groups in terms of the number of patients with at least one erosion (13.3 vs. 69%; p=0.003).In both groups the MASEI score correlated directly with the clinical MASES variables (rho=0.028) and inversely with Schöber Test values (rho=0.029).
Conclusions 33.3% of the IBD patients had an ultrasound score suggestive of spondiloarthritis. No differences in clinimetric and clinical variables in IBD patients with a MASEI score lower than 18 were observed. US entheseal abnormalities, PD signal and enthesophytes, were present in IBD patients in a similar percentage to that observed in the IBD+SpA patients.
Mcgonagle D, Khan MA, Marzo-Ortega H,et al. Enthesitis in spondyloarthropathy. Curr Opin Rheumatol 1999; 11: 244-250.
Bandinelli F, Milla M, Genise S, et al. Ultrasound discloses entheseal involvement in inactive and low active inflammatory bowel disease without clinical signs and symptoms of spondyloarthropaty. Rheumatology (Oxford) 2011; 50:1275-1279.
Disclosure of Interest None Declared
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