AB0491 THE IMPORTANCE OF MUSCULOSKELETAL SYMPTOM QUESTIONING IN INFLAMMATORY BOWEL DISEASES
Authors: B. Farisoğullari, O. Keskin, B. Usta, G. K. Yardimci, E. Parlak, T. Kav, U. Kalyoncu, O. Karadag
Journal: Annals of the Rheumatic Diseases (2021)

Background: Spondyloarthritis (SpA) occurs in up to 13% of patients with inflammatory bowel disease (IBD) (1). Early diagnosis and treatment of SpA in IBD patients prevents irreversible musculoskeletal diseases. Objectives: The aim of this study is to emphasize the importance of questioning musculoskeletal symptoms in patients with IBD. Methods: In the Hacettepe University Gastroenterology Clinic, patients with IBD were questioned for musculoskeletal symptoms between March 2019 and September 2020. For this purpose, a validated DETAIL questionnaire (2) consisting of six questions was asked (1. Have you ever had a finger or a toe and/or another joint swollen and painful for no apparent reason? 2. Occasionally, has an entire finger or toe becomes swollen, making it look like a ‘sausage’? 3. Have you had pain in your heels? 4. Have you ever had back pain lasting at least 3 months that was not injury related? 5. Do you have low back pain in the morning and/or after resting that improves with exercise? 6. Do you wake up at night because of low back pain?). Patients with at least 1 positive out of 6 questions were consulted in the rheumatology clinic, and patients were evaluated for SpA by physical examination, laboratory, and imaging. Demographic and clinical characteristics of IBD patients with and without SpA were compared. Results: 217 IBD patients were included in the study. Twenty patients with previously known rheumatologic diseases were excluded from the study. 49 (24%) of the remaining 197 patients had a positive answer to at least one question in the DETAIL query. 39 (20%) of these patients were evaluated in the rheumatology clinic, and 16 (8.1%) of them were diagnosed with SpA (spondylitis: 9, peripheral arthritis: 7) (Figure 1). There were no significant differences in terms of age, gender, IBD type, duration of IBD, current treatment, fibromyalgia syndrome (FMS) and depression according to Beck depression inventory between patients with IBD with and without SpA (Table 1). Table 1. Clinical, demographic characteristics of the IBD patients according to SpA. IBD with SpA n= 16 IBD without SpA n= 23 p Age, years, median (IQR ) 47.03 (27.4) 35.9 (14.1) 0.052 Female, n (% ) 8 (50) 17 (74) 0.12 IBD disease duration, months, median (IQR ) 66.7 (70.7) 44.8 (70) 0.26 IBD type, n (% ) CD 6 (37) 11 (48) 0.19 UC 9 (56) 12 (52) IC 1 (7) Smoking (ever), n (% ) 10 (62.5) 11 (48) 0.37 HLA-B27 positivity, n (% ) 2 (12.5) 1 (4.3) 0.57 Current medication, n (% ) - Steroid (oral and/or topical) 6 (37.5) 5 (21.7) 0.31 - 5-ASA 11 (68.8) 14 (61) 0.61 - Immunosuppressants (AZA, MTX) 6 (37.5) 8 (34.8) 0.86 - bDMARD 2 (12.5) 4 (17.4) 1 FMS, n (% ) 1 (6.7) 3 (13) 1 Beck depression Inventory, level of depression, n (% ) -minimal 1 (9) 5 (22) 0.13 -mild 8 (73) 7 (30) -moderate 2 (18) 9 (39) -severe 0 2 (9) Harvey-Bradshaw Index for CD disease activity and Mayo score for UC disease activity were used. SD: standard deviation, IQR: inter-quartile range IBD: inflammatory bowel disease; SpA: Spondyloarthritis , bDMARD: biological disease modifying anti-rheumatic drug , CD: Crohn’s disease, UC: Ulcerative colitis, IC: indeterminate colitis; HBI: Harvey-Bradshaw Index ASA: 5-aminosalicylic acid; AZA: azathioprine; MTX: methotrexate; FMS: Fibromyalgia syndrome Conclusion: By questioning the musculoskeletal system in IBD patients, 20% of the patients were evaluated in the rheumatology department, and nearly half of these patients (8%) were diagnosed with SpA. The findings point to the importance of musculoskeletal symptom questioning in routine outpatient clinic control in IBD patients. References: [1]Karreman MC et al. The prevalence and incidence of axial and peripheral spondyloarthritis in inflammatory bowel disease: a systematic review and meta-analysis. Journal of Crohn’s and Colitis, 2017, 11.5: 631-642. [2]Di Carlo M et al. The DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire: development and preliminary testing of a new tool to screen patients with inflammatory bowel disease for the presence of spondyloarthritis. Clinical rheumatology, 2018, 37.4: 1037-1044. Figure 1 Flow chart of IBD patients in the study Disclosure of Interests: None declared.