Alimentary Tract
Articular manifestations in inflammatory bowel disease patients: A prospective study

https://doi.org/10.1016/j.dld.2009.01.013Get rights and content

Abstract

Background and aims

Rheumatic manifestations are frequent in inflammatory bowel disease (IBD) and are associated with a wide range of clinical patterns.

Methods

Articular symptoms and signs were investigated by questionnaire in a cohort of 651 pts, mean age 42 ± 14 years, followed at two referral hospitals over a 12-month period.

Results

142 ulcerative colitis (UC) and 120 Crohn's disease (CD) patients referred articular pain during their IBD history: in 46% this was associated with active IBD, in 56% symptoms were intermittent and in 19% symptoms preceded IBD diagnosis. 62 pts (28 UC, 34 CD) complaining of articular symptoms at the time of the interview, were investigated by the rheumatologist: arthropathy was axial in 52%, oligoarticular in 16% and polyarticular in 23%. Oligoarthritis commonly involved the lower limbs and was more commonly associated with UC. The mean number of small joints involved was significantly higher in CD than in UC pts (9.9 ± 8.2 vs. 5.6 ± 4.3; p < 0.01). Bone scintigraphy was abnormal in 70% of pts.

Conclusions

Prevalence of self-reported articular symptoms in IBD patients exceeds 40% with 9.5% incidence during 1-year follow up. Symptoms predict entheropatic involvement of the locomotor system.

Introduction

Extraintestinal manifestations occur quite often in inflammatory bowel disease patients, sometimes in combination in different organs such as skin, joints and eyes suggesting a common, perhaps genetic, predisposing factor [1], [2], [3], [4], [5]. Arthropathy is by far the most common extraintestinal manifestation with frequency ranging from 4 to 23% depending on the diagnostic criteria used and on patient selection. The occurrence of ankylosing spondylitis seems quite infrequent, whilst peripheral patterns are far more frequent. Peripheral arthropathies may be pauciarticular involving the large joints or polyarticular usually symmetrical and involving preferably the small joints. These arthropathies are usually sero-negative, non-erosive and non-deforming.

Genetic susceptibility to spondyloarthropathy has been advocated since the documentation of an association between HLA-B27 and ankylosing spondylitis, tendinitis or uveitis [6] and postenteritic reactive arthritis [7]. Moreover, some of the identified loci are common to both ulcerative colitis and Crohn's disease whilst others are articular-specific. The relationship genotype–phenotype has been evaluated in a wide population of inflammatory bowel disease patients from Northern Europe [8], but such data are not available in other populations.

Clinical presentation has a very wide spectrum of symptoms which can be transient and mild to persistent and disabling. The course of the disease has been poorly elucidated: with few exceptions articular symptoms are thought to follow the clinical course of inflammatory bowel disease. The frequency of peripheral arthritis seems more common in patients with UC than CD and the occurrence of arthritis is frequently associated with colonic involvement in CD [9].

Aim of the study was to evaluate the clinical spectrum and the prevalence of articular manifestations by interviewing a cohort of inflammatory bowel disease patients and to characterise the type and severity of articular complaints in patients currently symptomatic.

Section snippets

Materials and methods

All inflammatory bowel disease patients attending the Gastroenterology Units of the University of Padua and the General Hospital of Vicenza over a 12-month period for acute symptoms or follow-up purposes, were investigated by questionnaire regarding articular symptoms. 651 patients were interviewed and 62 were referred for rheumatological evaluation because symptomatic. The rheumatologists performed biochemical and immunological tests, clinical evaluation and plain radiographic evaluation or

Results

The characteristics of the 651 patients included in the study are summarised in Table 1. According to the questionnaire, past articular symptoms were referred by 262 patients (142 UC and 120 CD). Pain was localised in the spine in 19% of the patients, in the peripheral joints in 45% and both in the peripheral joints and in the spine in 36% of the interviewed patients (Table 2).

117 patients have had a previous specialist consultation, which accounted for 45% of those referring symptoms. The

Discussion

Our study highlights a high cumulative rate of reported articular symptoms during 1-year course of the inflammatory bowel disease. An accurate work up of symptomatic patients demonstrates objective evidence of arthritis in most of the patients. CD is slightly more prone than UC to develop articular manifestations.

The results of the systematic investigation of all inflammatory bowel disease patients followed in two Gastroenterological Units for possible arthritis found 9.5% of positive patients.

Conflict of interest statement

All authors declare no actual or potential conflict of interest including any financial, personal or other relationships with other people or organisations.

References (29)

  • S. Brophy et al.

    Inflammatory eye, skin, and bowel disease in spondyloarthritis: genetic, phenotypic, and environmental factors

    J Rheumatol

    (2001)
  • J.T. Gran et al.

    Joint manifestations in gastrointestinal diseases

    Dig Dis

    (1992)
  • O. Palm et al.

    The prevalence and incidence of peripheral arthritis in patients with inflammatory bowel disease, a prospective population-based study (the IBSEN study)

    Rheumatology

    (2001)
  • C.H. Suh et al.

    Arthritic manifestations of inflammatory bowel disease

    J Korean Med Sci

    (1998)
  • Cited by (0)

    View full text