Alimentary TractArticular manifestations in inflammatory bowel disease patients: A prospective study
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.
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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.
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