Background Arthritis is the most common extraintestinal manifestation of inflammatory bowel disease (IBD) and occurs in 9 to 53% of the patients with this disease. IBD associated arthropathy is considered a subtype of seronegative spondyloarthropathy, with axial, peripheral, or a combination of both joint manifestations.
Objectives To evaluate the different types of joint involvement in patients with the diagnosis of Enteropathic arthritis at a single institution during five years.
Methods Chart review, from 2006 to 2011, of all patients diagnosed as having Enteropathic arthritis at the Rheumatology outpatient clinic of Santa Maria Hospital, Lisbon.
Results Sixty five patients, 26 men (40,0%) and 39 women (60,0%), were identified as having IBD: 45 with Crohn’s disease (CD) and 25 with ulcerative colitis (UC).
The mean age was 48,4 years [range 20-81 years]. The gastroenterological initial disease manifestations occurred at a mean age of 31,2 years [range 11-60 years] and the joints involvement started at a mean age of 35,2 years [range 14-62 years]. In most patients (63.1%) the bowel involvement preceded the arthritic manifestations, especially in UC (85,0%).
Peripheral arthritis was found in 64,6% of the patients (polyarthritis 52.3%, oligoarthritis 45,2% and monoarthritis 2,3%) affecting preferentially the knees (76.2%), ankles (52.4%) and hand small joints (42,9%). Radiographic erosions of de peripheral joints were only seen in 2 patients (hand and feet small joints).
Almost half the patients (49,2%) had low inflammatory back pain, started at a mean age of 30.3 years [range 16-50 years]. Radiographic sacroiliitis was found in 36.9% of the patients (27.7% unilateral) and spine involvement in 21,5% (mostly vertebral squaring and syndesmophytes).
Results of histocompatibility typing (HLA-B27) were found in 42 patients and only 7 showed HLA-B27 positivity (16,7%): 5 with CD and 2 with UC. Six of them had radiographic sacroiliitis (85,7%) and five (71,4%) had asymmetrical peripheral arthritis.
Conclusions In our small cohort of patients it was possible to identify a higher prevalence of joint manifestations in patients with CD, when comparing with UC. Peripheral arthritis, especially polyarthitis, was the most frequent type of joint involvement observed. Surprisingly, there were only 16.7% of positive HLA-B27 patients, similar to the prevalence found in the general population.
Arvikar SL et al.Inflammatory bowel disease associated arthropathy. Curr Rev Musculoskelet Med. 2011 Jun 28
Holden W et al. Enteropathic arthritis. Rheum Dis Clin North Am 2003; 29:513-530.
Disclosure of Interest None Declared
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