AB0893 CLINICAL AND ULTRASONOGRAPHIC ASSESSMENT OF ENTHESITIS AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASES
Authors: H. Ogun, A. Karakoc, S. N. Esatoglu, I. Hatemi, G. Hatemi
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> There is a well-known association between inflammatory bowel diseases (IBD) and spondyloarthritis (SpA) that can involve the axial, peripheral oligoarthritis, peripheral polyarthritis, enthesitis and dactylitis domains. Enthesitis has been reported among IBD patients without any other SpA features, but there is limited data on the frequency of enthesitis assessed with a standard methodology using clinical and ultrasonographic (US) examination, and in comparison with controls who have IBD associated SpA [1]. <h3>Objectives:</h3> The aim of this study was to determine the frequency and severity of enthesitis using clinical and ultrasonographic indexes among patients with IBD who do not have any other SpA features and to compare these to patients with IBD associated SpA. <h3>Methods:</h3> In this single-centre, cross-sectional study, IBD patients with or without SpA underwent a clinical evaluation of the entheses, and a B-mode and Power Doppler (PD) examination of 6 pairs of entheses. The clinical examinations were performed by two rheumatologists blinded to each other. Demographics, level of regular sports activity (defined as sports or physical activity at least once a week), body mass index (BMI), treatment modalities, and disease activity were recorded in all participants. The Crohn's Disease Activity Index (CDAI), Mayo score for ulcerative colitis, the Bath AS Disease Activity Index (BASDAI) were used for the assessment of disease activity of each condition. Patients were defined as having IBD associated SpA if they fulfilled ASAS criteria for SpA. For the clinical assesment of enthesitis Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index were used. US was performed by a single rheumatologist ultrasonographer and scored using the Madrid Ankylosing Spondylitis Enthesitis Index (MASEI). The MASEI-inflamatory (tendon structure, thickness and the PD), MASEI-damage (calcification and erosion) and MASEI-total scores were reported separately. Intra-observer reliability for US was determined by re-evaluation of the recorded images by the same ultrasonographer and calculating intraclass correlation coefficient (ICC). <h3>Results:</h3> We included 37 IBD patients who did not have SpA, and 46 IBD patients with SpA. The clinical characteristics of the patients are shown in Table 1. At least one enthesitis item was detected on US in 33/37 (89%) of IBD patients without SpA and 42/46 (91%) of IBD patients with SpA. Clinical examination showed at least one enthesitis item in 18/37 (49%) of IBD patients without SpA compared with 30/47 (64%) of IBD patients with associated SpA. The enthosopathy scores are shown in Table 2. Higher MASEI scores were found in IBD patients with SpA (12.2 ± 9.5) than IBD patients without SpA (7 ± 6.5) [p &lt; 0.05 for all comparisons]. All of the clinical examination scores were found higher in IBD patients with SpA than without SpA but the difference was not statistically significant. The intra-observer reliability for US was good, with an ICC of 0.89 (0.52–0.98). <h3>Conclusion:</h3> Enthesitis is a frequent complication of IBD, even among patients who do not have other features of SpA. US examination may increase the sensitivity for detecting enthesitis, compared with clinical examination alone. Screening IBD patients for enthesitis using US may be useful for early diagnosis and treatment. The specificty of US findings in this patient group needs to be further studied with other control groups. <h3>REFERENCES:</h3> [1] Sakellariou G, Schiepatti A, Scalvini D, Lusetti F, Fazzino E, Biagi F, Montecucco C. Musculoskeletal Ultrasound to Identify Subclinical Joint and Periarticular Involvement in Patients With Inflammatory Bowel Disease: A Systematic Literature Review. Front Med (Lausanne). 2022 May 16;9:919521. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Hande Ogun: None declared, Alican Karakoc: None declared, Sinem Nihal Esatoglu S.N.E has received honorariums for presentations from UCB Pharma, Roche, Pfizer and Merck Sharp Dohme., Ibrahim Hatemi: None declared, Gulen Hatemi G.H has received lecture fees from Celgene, Novartis, Abbvie, Amgen, and UCB Pharma, G.H has received consulting fees from Celgene, UCB Pharma, Bayer, and Johnson &amp; Johnson., G.H has received research grant from Celgene.