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FRI0466 Back pain and peripheral joint complaints in inflammatory bowel disease patients
  1. L. Brakenhoff1,
  2. R. van den Berg2,
  3. F. van Gaalen2,
  4. A. van der Meulen-de Jong1,
  5. T. Huizinga2,
  6. D. Hommes1,3,
  7. D. van der Heijde2,
  8. H. Fidder4
  1. 1Gastroenterology&Hepatology
  2. 2Rheumatology, LUMC, Leiden, Netherlands
  3. 3Center for Inflammatory Bowel Diseases, UCLA Health System, Los Angeles, United States
  4. 4Gastroenterology&Hepatology, UMCU, Utrecht, Netherlands


Background Arthropathies are the most common extraintestinal manifestation in patients with inflammatory bowel disease (IBD).

Objectives To characterize joint complaints in IBD patients and classify these complaints according to spondyloarthritis (SpA) criteria sets.

Methods In total, 138 IBD patients (77% Crohn’s Disease (CD), 23% ulcerative colitis (UC)) with back pain ≥3 months and/or peripheral joint pain and/or swelling during the last year were included. A complete rheumatologic examination was performed. SpA was defined according to the ASAS, ESSG and Amor criteria. The modified New York (mNY) criteria were used to classify patients as ankylosing spondylitis (AS). Peripheral arthralgia was defined as joint pain without swelling, arthritis as joint pain with swelling and dactylitis as a ‘sausage digit’ at clinical examination. HLA-B27 was typed.

Results Of the 138 patients, 12 patients (9%) reported chronic back pain, 72 (52%) patients peripheral joint complaints and 54 (39%) patients axial, as well as, peripheral involvement. Mean age was 43.3±13.3 yrs. Most patients with back pain (82%) had pain in the lumbar spine. Back pain developed after IBD diagnosis in 79% patients. The minority of patients (35%) reported that onset back pain occurred during IBD activity. There were no differences in frequency of back pain between CD and UC. Arthralgia was found in 121/126 (96%) patients, arthritis in 4 (3%) and dactylitis in 1 (1%) patient. CD patients had earlier age at onset and longer duration of peripheral complaints compared to UC (both p<0.05). Pain was monoarticular in 20 (16%), oligoarticular in 55 (44%) and polyarticular in 51 (41%) patients. Peripheral joint pain was more often continuous in CD than UC patients: 83% vs. 55% (OR3.82 95% CI1.55-9.40). Hands (34%) and knees (21%) were most often affected. The minority of patients (33%) reported that onset of peripheral joint complaints occurred during IBD activity. In 94/126 (75%) patients, onset of joint complaints developed after IBD diagnosis. Of the 138 patients, 7 (5%) were HLA-B27 positive. In total, 49/138 (36%) patients fulfilled any of the SpA criteria sets; 8 (6%) patients fulfilled the ASAS criteria (4 axial and 4 peripheral SpA), 18 (13%) the Amor criteria and 44 (32%) patients the ESSG criteria of which 39 patients fulfilled the IBP arm. Three (2%) patients fulfilled the mNY criteria for AS and these patients also fulfilled all SpA criteria sets.

Conclusions A third of IBD patients with joint complaints fulfill at least one of the SpA criteria sets. The ESSG criteria were fulfilled more often than the ASAS and Amor criteria due to the high number of IBD patients fulfilling IBP, which makes them fulfill the ESSG criteria. Most of these patients are probably false positives for the ESSG SpA criteria because IBP is not specific for SpA [ref]. Axial complaints are similar between CD and UC. However, CD patients have earlier age at onset of peripheral joint complaints, a longer duration of complaints and pain is more often continuous compared to UC. Hands and knees are the most often reported painful joints and arthralgia is the most frequent peripheral joint manifestation in IBD.

References van den Berg R et al. Ann Rheum Dis 2012 Nov 8

Disclosure of Interest None Declared

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