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AB0765 The Frequency of Subclinical Achilles Enthesopathy in Inflammatory Bowel Disease and its Relation with Vitamin D
  1. G. Kimyon1,
  2. D. Tekir2,
  3. B. Kısacık1,
  4. Y. Pehlivan3,
  5. M. Aydınlı4,
  6. A.M. Onat1
  1. 1Department of Rheumatology, Gaziantep University Faculty of Medicine, Gaziantep
  2. 2Deparment of Internal Medicine, Gerze State Hospital, Sinop
  3. 3Department of Rheumatology, Uludağ University Faculty of Medicine, Bursa
  4. 4Department of Gastroenterology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey


Background Extra-intestinal involvement is frequent in inflammatory bowel disease (IBD). The most common findings among these are musculoskeletal findings. Enthesitis spondyloarthritis (SpA) is one of the major findings of the disease. It has been demonstrated that vitamin D (Vit D) has effects on the immune system and vitamin D deficiency could be an important factor in the development of autoimmune rheumatologic diseases and in the progression of the disease.

Objectives The current study aimed to investigate the frequency of enthesopathy in patients with IBD and the relationship between vitamin D and enthesopathy.

Methods The current study included 100 patients with IBD (52 with ulcerative colitis (UC) and 48 with Crohn's disease (CD)) and 30 individuals as the control group. The ultrasonographic (US) evaluation of the patients was conducted by an experienced rheumatologist who was aware of the clinical conditions of the patients. The OMERACT enthesopathy scoring system was used for the evaluation of the Achilles tendon. Vitamin D levels <20ng/ml were accepted as deficient, between 20 and 32 ng/ml was accepted as insufficient, between 32 and 100 ng/ml was accepted as sufficient, and >100 ng/ml was accepted as excessive.

Results The mean age of the patients was 37.2 years for males and 40.1 years for females. US examination was performed in 200 heel regions of 100 patients. There was power Doppler (PD) change in 38 patients with UC and gray scale change in 20 patients in the US examination. PD change was detected in 12 patients with CD and gray scale change was detected in 12 patients. There was US change in 16 (30.8%) patients with UC and 9 (18.8%) patients with CD. The mean total US score of 52 patients with UC was 1.98±0.6, and that of 48 patients with CH was 0.83±0.7; the total US score of the control group was 0. The mean total US score of the patients with UC and CD was statistically different from the control group (p<0.001). Sacroiliitis was detected in two (3.8%) patients with UC and in three (6.2%) patients with CH (p=0.924). The mean vitamin D level was 14.72±9.12 in patients with UC and 11.86±5.93 in patients with CD; vitamin D level was 16.06±8.42 in the control group. The difference in vitamin D levels between the control and the disease groups was not significant (p=0.301). There was no correlation between the vitamin D levels and the total US scores (p=0.068).

Conclusions In the current study enthesitis was detected in 25% of the patients with asymptomatic IBD. There was no relation between the vitamin D levels, IBD, or enthesopathy.


  1. Greenstein AJ, Janowitz HD, Sachar DB. The ekstraintestinal complications of Crohn's disease and ulcerative colitis:a study of 700 patients. Medicine. 1976;55:401-12.

  2. Salvarani C, Vlachonikolis IG, van der Heijde DM, et al. Musculoskeletal manifestations in a population- based cohort of inflammatory bowel disease patients. Scand J Gastroenterol. 2001;36:1307-13.

  3. D'Agostino MA, Olivieri I. Enthesitis. Best Pract Res Clin Rheumatol. 2006 Jun;20(3):473-86.

  4. Gatenby P, Lucas R, Swaminathan A. Vitamin D deficiency and risk for rheumatic diseases: an update. Curr Opin Rheumatol. 2013 Mar;25(2):184-91.

Disclosure of Interest None declared

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