Background Arthralgia (joint pain without clinical synovitis) frequently occurs in patients with inflammatory bowel disease (IBD), resulting in a reduced quality of life compared to those without arthralgia [ref]. The underlying cause of arthralgia in IBD is unknown.
Objectives To assess whether subclinical inflammatory changes can be detected on MRI in patients with IBD and arthralgia.
Methods In this pilot study, painful hand (MCP, PIP and/or DIP) or knee joints, with continuous pain for more than 6 weeks, were scanned on a 1.5T extremity MRI in 15 IBD patients (12 Crohn’s disease and 3 ulcerative colitis) between 18 and 45 years of age. In addition, the same joints were scanned in a control group of 15 IBD patients without joint pain who were matched for type and disease duration of IBD, gender and age. All patients were clinically examined by a rheumatologist for the presence of pain and absence of arthritis. MR imaging was performed according to a standard arthritis protocol with intravenous contrast administration on the same day of the clinical examination. MR images blinded for clinical information were evaluated by two readers in consensus for the presence of joint fluid, synovitis, tenosynovitis, enthesitis, erosions, cartilage defects and bone marrow edema.
Results The mean age was 37.7 ± 5.4 years for IBD patients with arthralgia and 39.3 ± 5.3 years for the controls. MR imaging of the hand, either both MCP 2-5 and PIP 2-5 or PIP 2-5 and DIP 2-5 joints, was performed in 11 patients and matched controls, MRI of the knee in 4 patients and matched controls. In total 57 joints, 53 hand joints and 4 knee joints, were evaluated in both groups. Enthesitis was seen in three hand joints (MCP 2, MCP 3, PIP 3) of 2/11 (18%) arthralgia patients and in none of the control group (p=0.48). A small amount of subchondral bone-marrow edema was seen in the metacarpal head of two controls. In one (25%) patient with knee arthralgia, joint fluid and synovitis was appreciated, no abnormalities were observed in the matched controls (p=1.00).
Conclusions Synovitis was present in one IBD patient with knee arthralgia and enthesitis in two IBD patients with hand arthralgia on MRI. However, this was not statistically significant different from non-painful joints of IBD patients without arthralgia.
References Palm O et al. J Rheumatol 2005;32:1755-9
Disclosure of Interest None Declared
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