Prevalence of Subclinical Entheseal Involvement in Patients with Paediatric Inflammatory Bowel Disease: An Ultrasonographic Study

Alberto Batticciotto¹, Dario Dilillo², Marco Antivalle³, Martina Nugnes², Valentina Varisco¹, Matteo Ferrari², F. Atzeni³, Gian Vincenzo Zuccotti² and P. Sarzi-Puttini³, ¹Rheumatology, L. Sacco University Hospital, Milano, Italy, ²Pediatric Department, L. Sacco University Hospital of Milan, Milan, Italy, ³Rheumatology Unit, L. Sacco University Hospital of Milan, Milan, Italy

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Bowel, Enthesitis, Enthesopathy, pediatrics and ultrasonography

Session Information

Title: Imaging of Rheumatic Diseases: Ultrasound

Session Type: Abstract Submissions (ACR)

Background/Purpose

Joint involvement is the most frequent extra-intestinal manifestation of paediatric inflammatory bowel disease (IBD). Various recent studies focused on the clinical prevalence of enthesitis in children and adults with IBD¹, and others have demonstrated the ability of ultrasound (US) to visualise the acute and chronic signs of entheseal inflammation with greater sensitivity than a clinical examination, although there is a lack of consensus concerning the US definition of entheseal abnormalities and their prognostic value especially in the paediatric field². The aim of this study was to evaluate the prevalence of subclinical entheseal involvement in patients with pediatric IBD using a high frequency ultrasound probe.

Methods

Twenty-seven pediatric IBD patients (13 with Crohn’s disease [CD] and 14 with ulcerative colitis [UC]; 15 females and 12 males; mean age 13.7 years, range 7-21 years) without any clinical signs or symptoms of musculo-skeletal involvement and 24 healthy age- and gender-matched controls (14 females and 13 males; mean age 14.2 years, range 8-20 years) underwent an US examination (ESAOTE MyLAB 70 6-18 MHz linear array transducer). Brachial triceps, femoral quadriceps, Achilles, plantar fascia, and proximal and distal patellar entheses were all scored using the 0-136 Madrid Sonographic Enthesis Index (MASEI). Clinical and clinimetrical variables were assessed in both groups (MASES, BASDAI, BASFI, cHAQ, PCAI/PCDAI).

Results

None of the patients had a MASEI score suggesting early spondyloarthritis involvement but their average score was significantly higher than controls (3.15±2.84 vs 0.96±1.12, p=0.0006). There was also a significantly higher percentage of patients with at least one enthesis with power Doppler (PD) score ≥2 (37% vs 16%; p= 0.037) and at least one enthesis with dishomogeneous echostructure (59% vs 0%; p= 0.000). There were no between-group differences in terms of erosions (0% vs 0%), calcifications (7.4% vs 12.5%; p=0.656) or structural thickness (37% vs33.3%; p=0.507). In paediatric IBD group we cannot find correlation between the total MASEI score and gender (p=0.12), age (p=0.20), disease duration (p=0.18) or IBD activity (p=0.83).

Conclusion

US detectable enthesopathy is frequent in paediatric IBD patients without any clinical signs or symptoms of musculo-skeletal involvement. Further studies involving a larger number of patients are needed to confirm these preliminary data.

Disclosure:

A. Batticciotto,
None;

D. Dilillo,
None;

M. Antivalle,
None;

M. Nugnes,
None;

V. Varisco,
None;

M. Ferrari,
None;

F. Atzeni,
None;

G. V. Zuccotti,
None;

P. Sarzi-Puttini,
None.

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