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Abstract :
[en] Introduction/Aim. Joint involvement is the most frequent extra-intestinal manifestation of inflammatory bowel disease (IBD), but the associated clinical factors remain unknown. In this study, we assessed the frequency and characteristics of joint manifestations in a cohort of IBD patients, in order to identify IBD clinical predictors of articular symptoms.
Materials and Methods. Two independent rheumatologists evaluated IBD patients between January 2016 and August 2018 in CHU of Liège. First rheumatologist interrogated and examined the patients: IBD characteristics, rheumatic symptoms and other extra-intestinal manifestations, tender and swollen joints’ counts, SPARC and MASES indexes, Smythe points, axial metrology, HAQ and BASDAI questionnaires, Blood C reactive protein and fecal calprotectine levels and IBD activity indexes, were collected. Second rheumatologist performed a blind ultrasound of knee and ankle entheses. We tested for correlations between peripheral, axial and entheseal involvement and the collected variables in Crohn Disease (CD) and Ulcerative colitis (UC) patients through linear regression, and performed a cluster analysis.
Results. 199 patients were included: 143 CD (71.9%), 56 UC (28.1%). Mean intestinal disease duration was 14.47 ± 10.07 years. 79.4% reported arthralgia with an inflammatory pattern in 27.8%, 25.6 % entheseal pain and 14.8% axial inflammatory pain. Past peripheral involvement, in particular knee involvement was slightly higher in UC than in CD (p<0.05). Cluster analysis identified two groups of patients: first group (103, 51.8%), consisted of older patients, mostly CD, presenting more entheseal and peripheral involvement (p<0.001). When performing clustering in CD only, smoker women, presenting higher IBD activity (Pro2 Stool), more dermatological and hepatical comorbidities and more frequently treated with anti TNF drugs presented more peripheral and entheseal involvement and positive Smythe points (p<0.001).
Conclusion. Joint involvement was commonly found in our dataset. Our results suggest that CD women with an active bowel disease and extra-intestinal symptoms would be more prompt to develop articular manifestations.
