[en] Background and Aim: Radiographic sacroiliitis (SI), often asymptomatic, is considered the most frequent extra-intestinal manifestation (EIM) of Crohn's disease (CD). Data on the association of SI with other clinical features of CD are limited. Association of SI with CARD15 polymorphisms has recently been suggested. In a multicenter study, we investigated the association of SI in CD patients with clinical phenotypes, other EIM and CARD15 polymorphisms. Methods: Radiographs of the sacroiliac joints were taken in 251 CD patients from three Belgian university hospitals and scored by two blinded rheumatologists. Clinical features were obtained from medical records. Forty-three percent of patients carried at least one CARD15 polymorphism. Results: Sacroiliitis, defined as the presence of at least grade 2 unilateral changes, was diagnosed in 65 of the 244 scorable radiographs (27%). Only 16 of these patients were previously diagnosed with ankylosing spondylitis (AS). HLA-B27 positivity was observed in 53% of patients with AS and 7% of patients with radiographic SI. In univariate and multivariate analysis, associations between the presence of SI and peripheral arthritis (P = 0.005) and between AS and uveitis (P = 0.005) were found. No associations with other recorded clinical features or with CARD15 polymorphisms were observed. Conclusion: We confirm the high prevalence of radiographic sacroiliitis in a multicenter CD cohort. Uveitis is only associated with AS whereas all patients with SI are more prone to develop peripheral arthritis during their disease course, suggesting similar pathogenetic mechanisms in the development of these EIM. The previously reported association between SI and CARD15 polymorphisms was not confirmed.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Peeters, Harald
Cruyssen, Bert Vander
Mielants, Herman
de Vlam, Kurt
Vermeire, Séverine
Louis, Edouard ; Université de Liège - ULiège > Département des sciences cliniques > Hépato-gastroentérologie
Rutgeerts, Paul
Belaiche, Jacques ; Université de Liège - ULiège > Département des sciences cliniques > Hépato-gastroentérologie
De Vos, Martine
Language :
English
Title :
Gastroenterology - Clinical and genetic factors associated with sacroiliitis in Crohn's disease
Juillerat P, Mottet C, Froehlich F et al. Extraintestinal manifestations of Crohn's disease. Digestion 2005 71 : 31 6.
Su CG, Judge TA, Lichtenstein GR. Extraintestinal manifestations of Crohn's disease. Gastroenterol. Clin. N. Am. 2002 31 : 307 27.
Dougados M, van der Linden S, Juhlin R et al. The European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathies. Arthritis Rheum. 1991 34 : 1218 30.
De Vos M, De Keyser F, Mielants H, Cuvelier C, Veys E. Review article: bone and joint diseases in inflammatory bowel disease. Aliment. Pharmacol. Ther. 1998 12 : 397 404.
Orchard TR, Wordsworth BP, Jewell DP. Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut 1998 42 : 387 91.
Gravallese EM, Kantrowitz FG. Arthritic manifestations of inflammatory bowel disease. Am. J. Gastroenterol. 1988 83 : 703 9.
Mintz R, Feller ER, Bahr RL, Shah SA. Ocular manifestations of inflammatory bowel disease. Inflamm. Bowel. Dis. 2004 10 : 135 9.
Protzer U, Duchmann R, Hohler T et al. Enteropathic spondyloarthropathy in chronic inflammatory bowel disease: prevalence, pattern of manifestation and HLA association. Med. Klin. 1996 91 : 33 5.
Farmer RG, Hawk WA, Turnbull RB. Clinical patterns in Crohn's disease: a statistical study of 615 cases. Gastroenterology 1975 68 : 627 35.
Greenstein AJ, Janowitz HD, Sacher DB. The extra-intestinal complications of Crohn's disease and ulcerative colitis: a study of 700 patients. Medicine 1976 55 : 401 12.
de Vlam K, Mielants H, Cuvelier C, De Keyser F, Veys EM, De Vos M. Spondyloarthropathy is underestimated in inflammatory bowel disease: prevalence and HLA association. J. Rheumatol. 2000 27 : 2860 5.
Palm O, Moum B, Ongre A, Gran JT. Prevalence of ankylosing spondylitis and other spondyloarthropathies among patients with inflammatory bowel disease: a population study (the IBSEN study). J. Rheumatol. 2002 29 : 511 15.
Queiro R, Maiz O, Intxausti J et al. Subclinical sacroiliitis in inflammatory bowel disease: a clinical and follow-up study. Clin. Rheumatol. 2000 19 : 445 9.
Dekker-Saeys BJ, Meuwissen SG, Van Den Berg-Loonen EM, De Haas WH, Agenant D, Tytgat GN. Ankylosing spondylitis and inflammatory bowel disease. II. Prevalence of peripheral arthritis, sacroiliitis and ankylosing spondylitis in patients suffering from inflammatory bowel disease. Ann. Rheum. Dis. 1978 37 : 33 5.
Blum U, Buitrago-Tellez C, Mundinger A et al. Magnetic resonance imaging (MRI) for detection of active sacroilitis - a prospective study comparing conventional radiography, scintigraphy and contrast enhanced MRI. J. Rheumatol. 1996 23 : 2107 15.
Inanc N, Atagunduz P, Sen F, Biren T, Turoglu HT, Direskeneli H. The investigation of sacroiliitis with different imaging techniques in spondyloarthropathies. Rheumatol. Int. 2005 25 : 591 4.
Luong AA, Salonen DC. Imaging of the seronegative spondyloarthropathies. Curr. Rheumatol. Rep. 2000 2 : 288 96.
Steer S, Jones H, Hibbert J et al. Low back pain, sacroiliitis and the relationship with HLA-B27 in Crohn's disease. J. Rheumatol. 2003 30 : 518 22.
Davis P, Thompson AB, Lentle BC. Quantitative sacroiliac scintigraphy in patients with Crohn's disease. Arthritis Rheum. 1978 21 : 234 7.
Hyla JF, Franck WA, Davis JS. Lack of association of HLA B27 with radiographic sacroiliitis in inflammatory bowel disease. J. Rheumatol. 1976 3 : 196 200.
Huaux JP, Faissi R, De Bruyere M. HLA B27 in regional enteritis with and without ankylosing spondylitis or sacroiliitis. J. Rheumatol. 1997 4 : 60 3.
Peeters H, Vander Cruyssen B, Laukens D et al. Radiological sacroiliitis, a hallmark of spondylitis, is linked with CARD15 gene polymorphisms in patients with Crohn's disease. Ann. Rheum. Dis. 2004 63 : 1131 4.
Van der Linden S, Valkenberg HA, Cats A. Evaluation of diagnosis criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984 27 : 361 8.
Wright R, Lumsden K, Luntz MH, Sevel D, Truelove SC. Abnormalities of the sacro-iliac joints and uveitis in ulcerative colitis. Q. J. Med. 1965 34 : 229 36.
Lyons JL, Rosenbaum JT. Uveitis associated with inflammatory bowel disease compared with uveitis associated with spondyloarthropathy. Arch. Ophtalmol. 1997 115 : 61 4.
Veys EM, Mielants H, De Vos M, Cuvelier C. Spondyloarthropathies: from gut to targets organs. Baillieres Clin. Rheumatol. 1996 10 : 123 46.
Salmi M, Jalkanen S. Endothelial ligands and homing of mucosal leukocytes in extraintestinal manifestations of IBD. Inflamm. Bowel Dis. 1998 4 : 149 56.
Salmi M, Jalkanen S. Human leukocyte subpopulations from inflamed gut bind to joint vasculature using distinct sets of adhesion molecules. J. Immunol. 2001 166 : 4650 7.
Grant AJ, Lalor PF, Salmi M, Jalkanen S, Adams DH. Homing of mucosal lymphocytes to the liver in the pathogenesis of hepatic complications of inflammatory bowel disease. Lancet 2002 359 : 150 7.
Rudwaleit M, Baeten D. Ankylosing spondylitis and bowel disease. Best Pract. Res. Clin. Rheumatol. 2006 20 : 451 71.
Demetter P, Van Huysse JA, De Keyser F et al. Increase in lymphoid follicles and leukocyte adhesion molecules emphasizes a role for the gut in spondyloarthropathy pathogenesis. J. Pathol. 2002 198 : 517 22.
Nikkari S, Rantakokko K, Ekman P et al. Salmonella-triggered reactive arthritis: use of polymerase chain reaction, immunocytochemical staining, and gas-chromatography-mass spectrometry in the detection of bacterial components from synovial fluid. Arthritis Rheum. 1999 42 : 84 9.
Pacheco-Tena C, Alvarado De La Barrera C, Lopez-Vidal C et al. Bacterial DNA in synovial fluid cells of patients with juvenile onset spondyloarthropathies. Rheumatology 2001 40 : 920 7.
McEniff N, Eustace S, McCarthy C, O'Malley M, O'Morain CA, Hamilton S. Asymptomatic sacroiliitis in inflammatory bowel diseases. Assessment by computed tomography. Clin. Imaging 1995 19 : 258 62.
Salanti G, Sanderson S, Higgins JP. Obstacles and opportunities in meta-analysis of genetic association studies. Genet. Med. 2005 7 : 13 20.
Ott J. Issues in association analysis: error control in case-control association studies for disease gene discovery. Hum. Hered. 2004 58 : 171 4.
Shen H, Liu Y, Liu P, Recker RR, Deng HW. Nonreplication in genetic studies of complex diseases - lessons learned from studies of osteoporosis and tentative remedies. J. Bone Miner. Res. 2005 20 : 365 76.
Ahmad T, Tamboli CP, Jewell D, Colombel JF. Clinical relevance of advances in genetics and pharmacogenetics in IBD. Gastroenterology 2004 126 : 1533 49.
Bonen DK, Cho JH. The genetics of inflammatory bowel disease. Gastroenterology 2003 124 : 521 36.
Van Tubergen A, Heuft-Dorenbosch L, Schulpen G et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality? Ann. Rheum. Dis. 2003 62 : 519 25.