Background/Purpose
Musculoskeletal manifestations as peripheral arthritis, axial disease and enthesitis are present in 10-62% of Inflammatory Bowel Disease (IBD) patients. Ultrasonography is more sensitive than physical examination to detect enthesopathy and synovitis, so we believe it may be useful to identify subclinical involvement.
Our Purpose is to evaluate the presence of subclinical enthesitis and synovitis with power Doppler ultrasonography (PDUS) in IBD patients and to investigate its correlation with IBD variables.
Methods
Cross-sectional study that recruited prospectively IBD patients, without clinically overt musculoskeletal disease, attended by Gastroenterology during 2013. Gastroenterological, rheumatological and PDUS evaluation, blind to each other, were performed. Clinical assessment included demographics, comorbidities, IBD characteristics and musculoskeletal clinical examination. PDUS evaluation consisted of the detection of grey scale (GS) and power Doppler (PD) signs of enthesopathy and synovitis in 12 enthesis scored according to the Madrid Ankylosing Spondylitis Enthesitis Index (MASEI) and in 44 joints using a LOGIQ7 General Electric machine with a 12-MHz linear array transducer. Statistical analysis: continuous variables are expressed as mean±SD or range and categorical variables as number of cases (%). The associations between PDUS and clinical variables were evaluated by the Student’s t test, Mann-Whitney test, χ2 test or Pearson and Spearman correlations as appropriate. The intra-reader agreement for US was estimated in all the images obtained. Statistical significance was set at p<0.05 (Stata 10).
Results
A number of 23 (56.5% male) IBD patients [9 Crohn’s disease and 14 ulcerative colitis] have been included so far. Clinical variables: Age 42±12 years, evolution time 9 years (range: 0.1-33), CDAI 28±21, Mayo index 0.4±1, DMARD therapy in 91.3% for 5.5±5.3 years, ESR 12±8.8 mm/h and CRP 0.12±0.14 mg/dL. A positive MASEI was present in 95.7%, with a mean score of 35.2±9.5. GS enthesal abnormalities were found in at least 1 enthesis in 100% of patients: enthesophytes or calcifications (100%), altered echoestructure (100%), increased thickness (100%), erosion (13%) and bursitis (34.8%). GS joint effusion and synovial hypertrophy in at least 1 joint were present in 91.3% and 100%, respectively, with poliarticular (≥5 joints) involvement in 47.8% and 74%, respectively. Entheseal and joint PD signal was positive in 52.2% and 47.8% of patients, respectively. Joint effusion and synovial hypertrophy were more frequent in MTF, MCF and carpal joints and PD signal in carpal and knee joints. We found no association between PDUS variables and clinical or analytical IBD variables, probably due to the yet small sample size. The intra-reader agreement was high (0.8 intra-class correlation variability).
Conclusion
Subclinical joint and entheseal PDUS abnormalities are common in IBD patients, regardless of clinical subtype, evolution time and intestinal activity. Prospective longitudinal studies are needed to define its predictive value of clinically overt musculoskeletal disease and its association with structural deterioration.
Disclosure:
E. Vicente,
None;
S. Pérez-Esteban,
None;
M. Chaparro,
None;
F. Rodríguez-Salvanés,
None;
L. Vega,
None;
S. Castañeda,
None;
J. P. Gisbert,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-prevalence-of-subclinical-ultrasonographic-enthesopathy-and-synovitis-in-patients-with-inflammatory-bowel-disease-without-clinical-signs-or-symptoms-of-spondyloarthritis/