Background/Purpose:

Articular involvements are by far the most common extra-intestinal manifestations in inflammatory bowel disease (IBD). They include peripheral arthritis and inflammatory axial manifestation. Until now the prevalence of sacroiliitis in this same population was studied only on the structural plan. The main objective of this study was to estimate, for the first time, the prevalence of inflammatory sacroiliitis in IBD on digestive MRI defined according to ASAS (Assessment of SpondyloArthritis international Society) criteria. The secondary objective was to study the association between sacroiliitis and clinico-biological parameters in IBD.

Methods:

This study was performed on 186 patients suffering from IBD followed in a gastroenterology department between 2004 and 2011: 131 with Crohn’s disease (CD) (70.4%) and 55 with ulcerative colitis (UC) (29.6%). Clinico-biological and endoscopic data were collected and MR enterography or colonography was performed to assess IBD.

Two injected T1-weigthed sequences with fat saturation (FS) were used for the whole population: a coronal LAVA (liver acquisition with volume acceleration) sequence and an axial SPGR (spoiled gradient recalled) sequence. An additional injected axial LAVA sequence with FS was performed in 138 patients. On digestive MRI, sacroiliitis was scored blindly by two independent readers, a rheumatologist and a radiologist, according to ASAS criteria. The SIJ were graded bilateral, unilateral, normal and doubtful. In cases of discordance, the final diagnosis was obtained by consensus.

The association between sacroiliitis and the clinico-biological and radiological parameters of the digestive disease was analyzed by Fisher’s exact test or the chi-square test (qualitative variables) and by Wilcoxon’s test (quantitative variables) with a p value<0.05 as significant.

Results:

The prevalence of inflammatory sacroiliitis was 16.7% (31 patients). SIJ were considered as normal in 144 cases (77.4%) and doubtful in 11 cases (5.9%). Female gender in CD (p=0.01) and advanced age in both diseases (p=0.03) were associated with sacroiliitis on MRI. Disease duration tended to be associated with sacroiliitis (p=0.06), while other parameters such as the type of IBD, localization and extension of IBD, surgical history, biological inflammation, digestive activity, and type of treatment were not associated with sacroiliitis on digestive MRI.

Conclusion:

This study demonstrated for the first time the feasibility of using digestive MRI to establish the diagnosis of inflammatory sacroiliitis according to the ASAS criteria. Inflammatory sacroiliitis was evidenced by MRI in 1/6 patients suffering from IBD. This prevalence of sacroiliitis is probably underestimated due to technical and clinical factors (biologic treatment used). Added to clinico-biological data, MRI analysis should contribute to an earlier diagnosis of axial spondylarthritis in patients with IBD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-inflammatory-sacroiliitis-assessed-on-mr-imaging-of-inflammatory-bowel-disease-a-retrospective-study-performed-on-186-patients/