Background Enthesitis is categorized as inflammation of insertion of ligaments, tendons, joint capsule or fascia to bone and is a frequently under–diagnosed feature of spondylarthritis (Sp). In fact it has been demonstrated that clinical examination revealed enthesitis only in 5% in patients with inflammatory bowel disease (IBD). Detection of entheseal involvement is important to prevent disability and bone erosions in late disease. New imaging techniques such as ultrasonography (US) are performant tools to assess enthesitis in early phase.
Objectives The aim of this study was to investigate US enthesitis abnormalities in IBD patients without symptoms of Sp.
Methods A total of 19 patients followed-up for IBD were prospectively recruited for US examination. Only patients in inactive or low disease activity of IBD were screened. All patients showed no clinical evidence of arthritis or enthesitis. The Madrid Songraphic Enthesis Index (MASEI) was used to assess entheseal involvement. Six sites were bilaterally explored: distal quadricipital tendon (QT), proximal and distal patellar tendon insertion (PPT) and (DPT), distal Achilles tendon (AT), plantar fascia (PF) and distal brachial triceps tendon (TT). The US score evaluated enthesis thickness, structure, calcifications, power Doppler signals, erosions and bursae (for DPT and AT). US score for calcifications, Doppler and erosions ranged from 0 to 3, while scoring tendon thickness, structure and bursae was 0 (absent) or 1 (present).
Results Of the 19 patients examined, four had ulcerative colitis and 15 Crohn disease. The mean age was 32,5 years, 8 males and 11 females. The mean disease duration at the moment of US exam was 4,6 years [1-19 years]. Only one patient has ocular abnormality as extra-digestive manifestation. At inclusion two patients had low disease activity and the rest of them an inactive disease.
All patients (100%) presented at least one tendon alteration with mean MASEI 21,3 [4-56]. Enthesis thickness was noted in 84% and the PPT was the most affected. Structure damages were present in 21% of patients. Calcifications were found in 47% of patients and mean score was 1,1. The most frequent site was the AT. Power Doppler signals were detected in 16% of cases and erosions in 47% with a mean score at 3. Bursitis was noted in 36% of cases, one patient presented both retrocalcanel and infrapatellar bursitis. No significant correlation was found between MASEI and the disease duration (p=0,33) or the extension of the digestive disease (p=0,32).
Conclusions The relevance of this study is to show the high subclinical frequency of enthesopathy in IBD patients without clinical signs of Sp. These findings might influence the choice of treatment and elucidate the importance of strict collaboration between gastro-enterologists and rheumatologists.
Ultrasound discloses entheseal involevement in inactive and low active inflammatory bowel disease without clinical signs and symptoms of spondylarthropathy. Bandinelli F and Col. Rheumatology 2011
Validity of enthesis ultrasound assessement in spondylarthropathy. Miguel and col. Ann Rheum Dis 2009
Disclosure of Interest None declared