AB0862 An ultrasonographic study on entheseal involvement in asymptomatic patients with inflammatory bowel disease with or without spondyloarthritis
Authors: A. Batticciotto, F. Atzeni, M. Antivalle, M. Battellino, S. Ardizzone, P. Sarzi-Puttini
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Enthesis is defined as the insertion point of tendons, fascia or joint capsules into bones. This structure is typically affected by inflammatory rheumatic diseases (IRD), such as spondyloarthritis (SpA) [1].Now-a-days, limited data on ultrasonographic pattern in patients with enteropathic SA are available [2]. <h3>Objectives</h3> To evaluate, using a high frequency ultrasound probe, entheseal involvement in patients with inflammatory bowel disease (IBD) with and without spondiloarthritis (SpA), treated with anti-TNF drugs and clinically in remission. <h3>Methods</h3> 15 IBD patients [9 Crohn’s disease (CD) and 6 ulcerative colitis (UC); 8 females and 7 males with a mean age of 42 years (ranging from 26 to 72 years)] with low disease activity or in clinical remission were investigated with US (ESAOTE MyLAB 70 10-18 MHz linear array transducer) and compared with 16 patients with a previous diagnosis of IBD+ SpA [11 CD and 5 UC; 4 females and 12 males, with a mean age of 46.5 years (ranging from 26 to 71 years)]. Brachial triceps, femoral quadriceps, Achilleon, plantar fascia, and proximal and distal patellar entheses were all scored according to the 0-136 Madrid Sonographic enthesis index (MASEI). Correlation between MASEI and IBD variables was also evaluated. <h3>Results</h3> The clinical characteristics of IBD and IBD+SpA groups were similar for the following parameters: age (42.13±14.6 vs. 48.00±11.9; p=0.228); sex (p=0.149); BASDAI values (2.70 vs. 3.05; p=0.81); IBD activity (stools number/day: 2.00 vs. 1.75/day; p=0.794), BASFI (1.00 vs. 1.85; p=0.043); disease duration of IBD (7.93±5.4 years vs. 14.19±9.8 years; p=0.048); fingers to floor distance (11.00 cm vs. 33.00 cm; p=0.006). However, morning stiffness (0.00 min vs. 16.00 min; p=0.01) was higher in the IBD+SpA group compared with the IBD group. The median value of the MASEI score was significantly lower in IBD patients compared with IBD+SpA (14 <i>vs</i> 27; p=0.004) but the percentage of patients with MASEI score positive (&gt;18) wasn’t statistically different (33.3% vs 68.8%, Fisher’s test, p=0,056). Moreover, the percentage of patients with at least one power Doppler (PD) positive enthesis (47% <i>vs.</i> 69%; p=0.0285) and enthesophytes (93% <i>vs.</i> 100%), was not statistically different. We found a significant difference between the two groups in terms of the number of patients with at least one erosion (13.3 vs. 69%; p=0.003).In both groups the MASEI score correlated directly with the clinical MASES variables (rho=0.028) and inversely with Schöber Test values (rho=0.029). <h3>Conclusions</h3> 33.3% of the IBD patients had an ultrasound score suggestive of spondiloarthritis. No differences in clinimetric and clinical variables in IBD patients with a MASEI score lower than 18 were observed. US entheseal abnormalities, PD signal and enthesophytes, were present in IBD patients in a similar percentage to that observed in the IBD+SpA patients. <h3>References</h3> Mcgonagle D, Khan MA, Marzo-Ortega H,et al. Enthesitis in spondyloarthropathy. Curr Opin Rheumatol 1999; 11: 244-250. Bandinelli F, Milla M, Genise S, et al. Ultrasound discloses entheseal involvement in inactive and low active inflammatory bowel disease without clinical signs and symptoms of spondyloarthropaty. Rheumatology (Oxford) 2011; 50:1275-1279. <h3>Disclosure of Interest</h3> None Declared