Clinical and sonographic characteristics of enthesis lesions in inflammatory bowel disease
Authors:   Kazan State Medical University, Kazan, Russian Federation, Gainullina G.R. , Kirillova E.R. ,   Kazan State Medical University, Kazan, Russian Federation,   Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan, Russian Federation, Odintsova A.Kh. ,   Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan, Russian Federation, Abdulganieva D.I. ,   Kazan State Medical University, Kazan, Russian Federat,   Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan, Russian Federation
Published: October 2021

Aim: to assess enthesis lesions in patients with inflammatory bowel disease/IBD (ulcerative colitis/UC and Crohn’s disease/CD) and associations between the clinical pattern of the underlying disease and enthesopathy verified by ultrasound. Patients and Methods: this study included 95 patients with IBD aged 26–37 (the mean age was 37 years). Each patient underwent clinical examination and ultrasound of the entheses of the upper and lower extremities with calculating enthesial indices. The pattern of enthesopathy in patients with UC and CD was compared. Correlations between clinical characteristics of IBD and enthesopathy were evaluated. The analysis of individual anatomical sites of tendon and ligament insertions in patients with IBD was performed for the first time. Results: pain elicited on local pressure of entheseal points was seen in 52%. Enthesitis was diagnosed through ultrasound in 76% of patients (enthesitis with vascularization in 76%, erosions at insertions in 80%, and enthesophytes in 39%). When assessing anatomical sites, the most common impairment was a medial collateral ligament lesion, while the most common localization of enthesophytes was the insertion point of the quadriceps femoris muscle. Disease duration directly correlated to the number of painful entheses on palpation (SR=0.24, р=0.017) and the number of enthesophytes (SR=0.20, р=0.044). We failed to identify any significant associations between the severity of the attack and enthesis lesions in UC and CD. Direct correlations between the number of extraintestinal manifestations and the number of painful entheses on palpation (SR=0.35, р=0.0004) and LEI (SR=0.2, р=0.04) and GUESS scores (SR=0.28, р=0.004); the number of erosions with vascularization and ESR (SR=0.26, р=0.01) and CRP (SR=0.25, р=0.01); the number of painful entheses on palpation and the number of enthesitis (SR=0.71, р=0.00) including those with vascularization (SR=0.27, р=0.00) were revealed. Conclusion: enthesopathy is a common extraintestinal manifestation of IBD independent of a nosology of the severity of the attack of the underlying disease. Greater disease duration, pain at entheses on palpation, and increased inflammatory markers (ESR, CRP) are associated with enthesis lesions. Therefore, current enthesopathy indices can be applied to assess and monitor entheses. KEYWORDS: inflammatory bowel disease, ultrasound, enthesitis, vascularization, Power Doppler imaging, enthesopathy scores. FOR CITATION: Gainullina G.R., Kirillova E.R., Odintsova A.Kh., Abdulganieva D.I. Clinical and sonographic characteristics of enthesis lesions in inflammatory bowel disease. Russian Medical Inquiry. 2021;5(6):385–390 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-385-390.