Background Musculoskeletal symptoms accompanying the diagnoses of Inflammatory bowel diseases (IBD), are seen in 6 -46% of cases1. There are very limited data about prevalence of rheumatic manifestations of IBD from the Middle East 2.
Objectives The goal of this study is to examine the prevalence of rheumatic manifestations among patients diagnosed with IBD.
Methods Between 1/2/2015 and 30/7/2016 all consecutive IBD patients were approached. A total of 127 adult patients signed the consent form. The diagnosis and extent of IBD (ulcerative colitis or Crohn's disease) had to be confirmed by a colonoscopy and histopathology. Patients were then interviewed and examined by one of two expert rheumatologists. A set of questions were used, complete rheumatological examination, X-rays of the lumbosacral and SI joints, and HLA-B27 test were done.
Results Among our sample; 66% were Arabs and 34% are Asians, 58.3% were males, 52% fell in the age category of 30–49 years, 83.1% were married, 25.6% had a graduate degree, 36.5% had a history of smoking, and 15.2% had a family history of IBD.
The sample had 36%% with Crohn's disease, and 64% with ulcerative colitis. Any type of rheumatic manifestations were present in of 57.5% with no significant differences between the the two types of IBD diseases (p>0.05). The majority of these patients had peripheral manifestations (arthralgia, arthritis, enthesitis) (43.3%), while only 3.1% had axial alone, and 11% had both types. Among those with peripheral manifestations; 7.2% had type 1 arthritis (Pauciarticular), while 1.4% had type 2 arthritis (polyarticular). There were no significant differences between the two types of IBD diseases in regards to the presence of peripheral manifestations (p>0.05). However, the two diseases were significantly different in the presence of axial manifestations as more people with Crohn's have axial manifestations (19.6%) compared with Ulcerative colitis (12.3%). Those with Crohn's had more people with rheumatic manifestations 4–7 years before the diagnosis of IBD. HLA-B27 was positive in 5 patients 3 with Crohn's and 2 with ulcerative colitis. Logistic regression analysis of the data did not reveal any significant predictor or potential risk (type of IBD, gender, age group, BMI, smoking, family history, duration or extent) for the development of musculoskeletal manifestations in our patients.
Conclusions In this study of musculosketal manifestations of patients with IBD from the Middle East 57.7% of them have any rheumatic manifestations.Peripheral manifesations occurred in 43%, axial alone in 3.1%, axial and peripheral manifestations in 11.5%, type I arthritis in 7.2% and type II in 1.4%. More patients with Crohn's has axial spondyloarthropathy (19.6%) compared with patients with ulcerative colitis (12.3%).
Atzeni F et al: Rheumatic manifestations in IBD. Autoimmunity reviews: 2014 pp 20–23.
Al-Jarallah K, et al. Rheumatic complications of IBD among Arabs. Int J of rheum Dis 2013:16:134–138.
Disclosure of Interest None declared
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