Background Musculoskeletal manifestations occur in 20-50% of patients (pts) with inflammatory bowel disease (IBD) and they have an impact on the clinical course and therapeutic approach.
Objectives To summarize the rheumatologic manifestations of IBD pts referred to the rheumatology service in a tertiary referral center and to assess the impact of gastro-rheumatologic inter-disciplinary clinic on patient management.
Methods Medical records of 100 consecutive IBD pts referred to rheumatology unit and the inter-disciplinary clinic were retrospectively reviewed. Data regarding age, gender, diagnosis, disease duration, clinical and laboratory features, previous and current therapy were entered into a database and analyzed. The statistical methods used included descriptive statistics, T test, Spearman's correlation and multiple logistic regression analysis.
Results Seventy pts suffered of Crohn's disease, 29 of ulcerative colitis, and 1 patient of celiac disease. The mean (median) age was 43 (41.5) years, 68 pts were females, the mean (median) disease duration 7.7 (5) years, range 0-40 years. The referrals were for joint pain (73%), back pain (15%), myalgia (3%), fever (2%), and miscellaneous (7%). Spondyloarthropathy was diagnosed in 56 out of 88 pts referred for joint or back pain (35 pts with peripheral arthritis, 13 pts with axial involvement - symptomatic sacroiliitis or spondylitis, confirmed by imaging and 8 pts with enthesopathies). Hypermobility was found in 18 pts referred for joint pain. The other “musculoskeletal” entities included avascular necrosis of hips (2pts), Takayasu arteritis (1patient), IBD related myositis (1patient), steroid-induced myopathy (2pts), systemic lupus erythematosus (1patient), pseudogout (1patient), insufficiency fractures (1patient) osteoarthritis (2pts).Seventeen pts developed chronic peripheral arthritis which did not correlate to IBD activity and did not consistently respond to IBD-targeted immunomodulatory treatment, including anti-TNF agents, but responded to non anti-TNF biologicals. Nine pts had psoriasis or familial history of psoriasis; all of them developed chronic arthropathy (peripheral or axial). The assessment of the patients at the inter-disciplinary clinic had an important impact on the management in almost 70% of cases referred.
Conclusions An accurate assessment of joint inflammation in the context of IBD activity may lead to changes in the use of disease modifying drugs or biological agents. Not every joint or back pain in IBD pts is arthritis or spondyloarthropathy. The treatment of IBD pts with chronic arthritis in whom the IBD is silent should be focused on articular inflammation. We suggest that multidisciplinary clinic might have an important role in correctly diagnosing and treating rheumatologic manifestations in IBD pts.
Disclosure of Interest None declared
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