A2.6 Enthesis inflammation in inflammatory bowel diseases without spondyloarthritis
Authors: R Martínez-Pérez, E Rejón Gieb, S Rodríguez Montero, M León, J L Marenco de la Fuente
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Introduction</h3> During the past century has found an interesting interconnection between some intestinal diseases and arthritis. This link is most evident in inflammatory bowel disease (IBD), Crohn disease (CD) and ulcerative colitis (UC) with spondyloarthritis (SpA). Between 5 to 10% of patients with ankylosing spondylitis (AS) also suffer from IBD, either Crohn disease or ulcerative colitis, with clinical expression. <h3>Objective</h3> To investigate whether patients with inflammatory bowel diseases (IBD) have enthesis alterations comparable with those in patients with spondylarthritis (SpA). <h3>Methods</h3> A blinded, controlled study of enthesis evident on ultrasound (US) examination was performed in 30 patients with IBD and 10 healthy controls. In total, 12 enthesis locations were explored in each patient and control subject by 2 ultrasonographers who were blinded with regard to the diagnosis. A newly developed US method, the Madrid sonography Enthesitis Index (MASEI), in which the diagnosis of SpA is determined as a cutoff score of 18 points, was used. <h3>Results</h3> 30 inflammatory bowel diseases patients were included (13 women and 17 men) and 10 healthy controls (6 women and 4 men). The mean age was 43.88 ± 14.13 years in the IBD group and 46.50 ± 11.03 years in control group. The evolution time of inflammatory bowel diseases was 7.92 ± 4.85 years. At least some grade of sacroilitis on x-ray was present in 2 patients. 60% of patients with IBD had inflammatory joint pain compared to 20% of the healthy group. 36% of patients with IBD had low back pain but only 8% met Rudwaileitt criteria. HLA-B27 was negative in 100% patients. The MASEI score achieved statistical significance for gender. The ultrasound score was 19.44 ± 9.40 in inflammatory bowel diseases patients and 10.4 ± 8.31 in healthy control. The MASEI score was abnormal in 68% patients with IBD and 20% in healthy control group. <h3>Conclusions</h3> Our findings indicate that a high percentage of patients with inflammatory bowel diseases without features of SpA have enthesis lesions comparable with those seen in patients with SpA. These data suggest that patients with inflammatory bowel diseases, have an abortive or incomplete form of SpA. The enthesis ulttrasound score in Inflammatory Bowel Diseases may be useful for improving the diagnostic accuracy of early spondyloarthritis in this patients. <h3>Bibliography</h3> de Miguel E, Muñoz-Fernández S, Castillo C, Cobo-Ibáñez T, Martín-Mola E. Diagnostic accuracy of enthesis ultrasound in the diagnosis of early spondyloarthritis. <i>Ann Rheum Dis</i>. 2011 Mar;70(3):434-9. Cobo-Ibáñez T, Muñoz-Fernández S, De Miguel E, Díez Sebastián J, Steiner M, Martín-Mola E. One year clinical and ultrasonographic follow up of the pilot study for the referral of patients with early spondyloarthritis (ESPIDEP). <i>Reumatol Clin</i>. 2011 Jul-Aug;7(4):230-5. Muñoz-Fernández S, de Miguel E, Cobo-Ibáñez T, Madero R, Ferreira A, Hidalgo MV, Schlincker A, Martín-Mola E. Enthesis inflammation in recurrent acute anterior uveitis without spondylarthritis. <i>Arthritis Rheum</i>. 2009 Jul;60(7):1985-90.