Session Type: Abstract Submissions (ACR)
Joint manifestations frequently occur in chronic inflammatory bowel diseases (IBD). Arthralgia, non-inflammatory joint pain without objective evidence of swelling or effusion, is present in 8-30% of all patients.(1-3) An underlying cause of arthralgia in IBD patients is not known and might be autoimmune related, which might express on MR as bone marrow edema. The purpose of this study is to assess whether inflammatory changes, including bone marrow edema can be detected on MRI in IBD patients with joint pain without clinical synovitis.
The most painful peripheral joint, without clinical signs of inflammation based on examination by a rheumatologist, at most 2 weeks prior to MR, was scanned in 14 IBD patients (11 Crohn’s disease/3 ulcerative colitis) on a 1.5T extremity MRI. In addition the same joints were scanned in a control group of 14 IBD patients who were matched for form of IBD, disease duration, sex and age without joint complaints. MR imaging was performed according to a standard arthritis protocol including T1 and fat-suppressed T2 weighted images and T1 weigthed fat-suppressed post gadolinium sequences. MRI images were evaluated by two musculoskeletal radiologists in consensus for the presence of synovitis, tenosynovitis, bone marrow edema and erosions. The readers were blinded for all patient information.
MR imaging of the MCP, PIP and/or DIP 2-5 joints of the hand was performed in 10 patients and 10 matched controls, MRI of the knee in 4 patients and 4 matched controls. A total amount of 62 painful joints were evaluated and 62 corresponding joints in the control group. Minimal synovitis was seen in one of the MCP joints in two of the arthralgia patients (3.2% of all painful joints) and in none of the control group (p=0.50). Bone marrow edema was not appreciated in the arthralgia patients, but a small amount of bone-marrow edema was seen in a MCP joint of a control (1.6% of total joints, p=1.00). Tenosynovitis and erosions were absent in both groups.
Subclinical inflammation on MRI was not seen more often in painful joints in arthralgia patients than in joints of controls. No anatomical substrate was found for arthralgia in IBD patients.
1. Palm Ø, Bernklev T, Moum B, Gran JT. Non-inflammatory joint pain in patients with inflammatory bowel disease is prevalent and has a significant impact on health related quality of life. J. Rheumatol. 2005 Sep;32(9):1755–9.
2. Orchard TR, Wordsworth BP, Jewell DP. Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut 1998 Mar;42(3):387-91.
3. 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 Dec;27(12):2860-5.
L. K. P. M. Brakenhoff,
F. A. van Gaalen,
D. van der Heijde,
H. H. Fidder,
D. W. Hommes,
J. L. Bloem,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/magnetic-resonance-imaging-in-inflammatory-bowel-disease-patients-with-arthralgia/