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Malik F, Weisman MH. Sacroiliitis in inflammatory bowel disease. Curr Opin Rheumatol 2024; 36:274-281. [PMID: 38687285 DOI: 10.1097/bor.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE OF REVIEW This review summarizes the recent evidence regarding the epidemiology of inflammatory bowel disease (IBD) associated sacroiliitis, including the prevalence, pathogenesis, role of imaging, and therapeutic challenges. RECENT FINDINGS Sacroiliitis is an underappreciated musculoskeletal manifestation of IBD, a chronic inflammatory condition of the gut affecting the younger population. Untreated sacroiliitis can lead to joint destruction and chronic pain, further adding to morbidity in IBD patients. Recent publications suggest sacroiliitis can be detected on abdominal imaging obtained in IBD patients to study bowel disease, but only a small fraction of these patients were seen by rheumatologists. Early detection of IBD-associated sacroiliitis could be achieved by utilization of clinical screening tools in IBD clinics, careful examination of existing computed tomography and MRI studies, and timely referral to rheumatologist for further evaluation and treatment. Current treatment approaches for IBD and sacroiliitis include several targeted biologic therapies, but IBD-associated sacroiliitis has limited options, as these therapies may not overlap in both conditions. SUMMARY With the advances in imaging, sacroiliitis is an increasingly recognized comorbidity in IBD patients. Future studies focusing on this unique patient population will expand our understanding of complex pathophysiology of IBD-associated sacroiliitis and lead to identification of novel targeted therapies for this condition.
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Affiliation(s)
- Fardina Malik
- Division of Rheumatology, New York University Grossman School of Medicine, New York, New York
| | - Michael H Weisman
- Division of Rheumatology, Stanford University School of Medicine, Stanford, California, USA
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Kim DK, Lee KC, Kim JK. Sacroiliitis in inflammatory bowel disease on abdominal computed tomography: prevalence, misses, and associated factors. Scand J Rheumatol 2024:1-7. [PMID: 38686835 DOI: 10.1080/03009742.2024.2337453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To evaluate the prevalence and rate of a missed diagnosis of sacroiliitis on abdominal computed tomography (CT) in patients with inflammatory bowel disease (IBD). Factors associated with sacroiliitis were also assessed. METHOD This retrospective study included 210 patients with IBD (mean age 31.1 years) who underwent abdominal CT. Based on a validated abdominal CT scoring tool, bilateral sacroiliac (SI) joints on abdominal CT in the whole study population were retrospectively reviewed. Subsequently, patients were classified into the 'patients with sacroiliitis' group and the 'patients without sacroiliitis' group. Univariate and multivariate regression analyses were used to clarify the factors associated with sacroiliitis. RESULTS Sacroiliitis was identified in 26 out of 210 patients (12.4%). However, sacroiliitis was recognized on the primary reading in only five of these 26 patients (19.2%) and was missed on the initial report in the remaining 21 patients (80.8%). Among the 21 patients, 20 (95.2%) were finally diagnosed with axial spondyloarthritis (axSpA). There was a higher prevalence of female sex (p = 0.04), upper gastrointestinal involvement (p = 0.04), and back pain (p < 0.01) in patients with sacroiliitis than in those without sacroiliitis. However, on multivariate analysis, back pain was the only factor associated with sacroiliitis (p = 0.01). CONCLUSION Physicians should carefully evaluate SI joints on abdominal CT in patients with IBD to enable early detection of sacroiliitis, potentially leading to an early diagnosis of axSpA. In addition, if patients with IBD present with back pain, the possibility of sacroiliitis should be considered.
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Affiliation(s)
- D K Kim
- Department of Radiology, The Armed Forces Capital Hospital, Seongnam, Republic of Korea
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - K-C Lee
- Department of Radiology, The Armed Forces Capital Hospital, Seongnam, Republic of Korea
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - J K Kim
- Department of Radiology, The Armed Forces Capital Hospital, Seongnam, Republic of Korea
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Melekh O, Barajas Ordonez F, Melekh B, Rodríguez-Feria P, Pech M, Flintrop W, Surov A. Association between sacroiliac joint forms and subchondral changes in patients with Crohn's disease. Int J Rheum Dis 2024; 27:e15046. [PMID: 38414165 DOI: 10.1111/1756-185x.15046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 02/29/2024]
Abstract
AIM To assess the relationship between anatomical variants of sacroiliac joint (SIJ) and subchondral changes detected in magnetic resonance enterography (MRE) in patients with Crohn's disease (CD). METHODS This was a retrospective study of 60 CD patients, who were divided into two groups: with (n = 16) and without SIJ (n = 44) involvement, depending on the presence of inflammatory (bone marrow edema) and structural changes (sclerosis and erosions) in MRE. Anatomical variants of SIJ were assessed in CT of the abdomen and/or pelvis, distinguishing typical form with convex iliac surface and atypical forms. Univariate and multivariate analyses were performed to reveal an association between joint changes and forms. RESULTS Our study included 60 patients (38 males; mean age 38.72 years ± 13.33). Patients with SIJ changes were older (p = .044). No significant differences in CD localization and behavior were found. The most common SIJ lesions were structural changes (in 75% of patients); the main atypical form was the iliosacral complex. The univariate and multivariate analyses showed a significant association of atypical forms with total subchondral changes (odds ratio [OR]: 3.429, 95% confidence interval [CI] 1.043-11.268; p = .042; OR: 5.066, 95% CI: 1.273-20.167; p = .021, respectively), and with structural changes (OR: 4.185, 95% CI: 1.155-15.160; p = .029; OR: 5.986, 95% CI: 1.293-27.700; p = .022, respectively). CONCLUSION Atypical forms of SIJ are a risk factor for the occurrence of structural joint changes in CD patients. An association between bone marrow edema and atypical forms was not found.
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Affiliation(s)
- Oksana Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Felix Barajas Ordonez
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH, Aachen, Germany
| | - Bohdan Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Pablo Rodríguez-Feria
- Department of International Health, CAPHRI - Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Wiebke Flintrop
- Department of Pediatrics, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Institute for Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital by Muehlenkreiskliniken, Ruhr University Bochum, Minden, Germany
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Screening for spondyloarthritis in patients with inflammatory bowel diseases. Rheumatol Int 2023; 43:109-117. [PMID: 36161358 DOI: 10.1007/s00296-022-05208-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/07/2022] [Indexed: 02/02/2023]
Abstract
Inflammatory bowel diseases (IBDs) can be associated with various musculoskeletal (IBD-MSK) manifestations that could be difficult to classify for gastroenterologists. We aimed to evaluate the characteristics of patients with IBD-MSK and the prevalence of spondyloarthritis (SpA). In this observational cross-sectional study, we included patients with IBD-MSK complaints (peripheral or back pain). All patients underwent a standardized rheumatology evaluation including clinical, biological and imaging evaluations (MRI of spine and sacroiliac joints and ultrasonography of enthesis). We included 183 IBD patients (60.7% women; median [interquartile range] age 45 [36-56] years); 159 (87%) had joint pain. In 43 (23.5%) and 25/175 (14.3%) patients, enthesis abnormalities were found on ultrasonography and sacroiliitis on MRI, respectively. SpA was diagnosed in 54 (29.5%) patients. IBD-related arthralgia and degenerative spine disease were diagnosed in 105 (57.4%) and 72 (39.3%) patients. Sixteen (29.6%) SpA patients initiated a new conventional synthetic disease modifying anti-rheumatic drug (DMARD). A biologic DMARD was initiated in 10 patients or changed in 3. More than half of IBD-MSK patients had IBD-related arthralgia, and about one-third had definite SpA. Ultrasonography of enthesis and systematic MRI of sacroiliac joints seem useful for SpA classification and differential diagnosis in these patients who often have musculoskeletal pain complaints. Therapeutics were changed in most patients, which highlights the need for a multidisciplinary approach for managing IBD with extra-intestinal symptoms.
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Lim CSE, Tremelling M, Hamilton L, Kim M, Macgregor A, Turmezei T, Gaffney K. Prevalence of undiagnosed axial spondyloarthritis in inflammatory bowel disease patients with chronic back pain: secondary care cross-sectional study. Rheumatology (Oxford) 2022; 62:1511-1518. [PMID: 35993905 DOI: 10.1093/rheumatology/keac473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/06/2022] [Accepted: 08/06/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To elucidate the prevalence of undiagnosed rheumatologist-verified diagnosis of axial spondyloarthritis (RVD-axSpA) in patients attending routine secondary care IBD clinics with chronic back pain. METHODS Screening questionnaires were sent to consecutive patients attending IBD clinics in a university teaching hospital. Patients fulling the eligibility criteria (gastroenterologist-verified diagnosis, 18-80 years old, biologic therapy naïve, no previous diagnosis of axSpA); and a moderate diagnostic probability of axSpA (self-reported chronic back pain [CBP] > 3 months, onset < 45 years) were invited for rheumatology assessment. This included medical review, physical examination, patient reported outcome measures, human leucocyte antigen B27, C-reactive protein, pelvic radiograph and axSpA protocol magnetic resonance imaging. A diagnosis of RVD-axSpA was made by a panel of rheumatologists. RESULTS Of the 470 patients approached, 91 had self-reported CBP > 3 months, onset < 45 years, of whom 82 were eligible for clinical assessment. The prevalence of undiagnosed RVD-axSpA in patients attending IBD clinics in a secondary care setting, with self-reported CBP, onset < 45 years is estimated at 5% (95% CI 1.3,12.0) with a mean symptom duration of 12 (S.D. 12.4) years. CONCLUSION There is a significant hidden disease burden of axSpA among IBD patients. Appropriate identification and referral from gastroenterology is needed to potentially shorten the delay to diagnosis and allow access to appropriate therapy.
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Affiliation(s)
- Chong Seng Edwin Lim
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Mark Tremelling
- Gastroenterology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Louise Hamilton
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Matthew Kim
- Radiology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Alexander Macgregor
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Tom Turmezei
- Radiology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Karl Gaffney
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
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Ergenc I, Kani HT, Gundogmus CA, Ergelen R, Afsar N, Ekinci G, Atagunduz MP. Presence of axial spondyloarthritis associated sacroiliitis and structural changes on MR enterography: A direct comparison with sacroiliac joint MRI. Clin Imaging 2022; 92:19-24. [DOI: 10.1016/j.clinimag.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 11/03/2022]
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Cereser L, Zancan G, Giovannini I, Cicciò C, Tinazzi I, Variola A, Bramuzzo M, Murru FM, Marino M, Tullio A, De Vita S, Girometti R, Zabotti A. Asymptomatic sacroiliitis detected by magnetic resonance enterography in patients with Crohn's disease: prevalence, association with clinical data, and reliability among radiologists in a multicenter study of adult and pediatric population. Clin Rheumatol 2022; 41:2499-2511. [PMID: 35389115 DOI: 10.1007/s10067-022-06143-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/11/2022] [Accepted: 03/19/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Patients with Crohn's disease (CD) usually undergo magnetic resonance enterography (MRE) for evaluating small bowel involvement. Musculoskeletal symptoms are the most frequent extraintestinal manifestation in inflammatory bowel diseases, especially in CD, with sacroiliitis at imaging occurring in about 6-46% of patients and possibly correlating with axial spondyloarthritis. The primary study aim was to assess the prevalence of sacroiliitis in adult and pediatric patients with CD performing an MRE. We also evaluated the inter-rater agreement for MRE sacroiliitis and the association between sacroiliitis and patients' clinical data. METHOD We retrospectively identified 100 adult and 30 pediatric patients diagnosed with CD who performed an MRE between December 2012 and May 2020 in three inflammatory bowel disease centers. Two radiologists assessed the prevalence of sacroiliitis at MRE. We evaluated the inter-rater agreement for sacroiliitis with Cohen's kappa and intraclass correlation coefficient statistics and assessed the correlation between sacroiliitis and demographic, clinical, and endoscopic data (Chi-square and Fisher's tests). RESULTS The prevalence of sacroiliitis at MRE was 20% in adults and 6.7% in pediatric patients. The inter-rater agreement for sacroiliitis was substantial (k = 0.62, p < 0.001) in the adults and moderate (k = 0.46, p = 0.011) in the pediatric cohort. Age ≥ 50 years and the time between CD diagnosis and MRE (≥ 86.5 months) were significantly associated with sacroiliitis in adult patients (p = 0.049 and p = 0.038, respectively). CONCLUSIONS Sacroiliitis is a frequent and reliable abnormality at MRE in adult patients with CD, associated with the age of the patients ≥ 50 years and CD duration.
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Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy.
| | - Giovanni Zancan
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Carmelo Cicciò
- Department of Diagnostic Imaging and Interventional Radiology, IRCCS Sacro Cuore Don Calabria Hospital, via don A. Sempreboni, 5-37024, Negrar di Valpolicella, Verona, Italy
| | - Ilaria Tinazzi
- Department of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, via don A. Sempreboni, 5-37024, Negrar di Valpolicella, Verona, Italy
| | - Angela Variola
- Department of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, via don A. Sempreboni, 5-37024, Negrar di Valpolicella, Verona, Italy
| | - Matteo Bramuzzo
- Gastroenterology, Digestive Endoscopy, and Nutrition Unit Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Via dell Istria 65/1-34137, Trieste, Italy
| | - Flora Maria Murru
- Pediatric Radiology, IRCSS Burlo Garofolo, Via dell'Istria 65/1-34137, Trieste, Italy
| | - Marco Marino
- Department of Gastroenterology, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital S. Maria Della Misericordia, p.le S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Annarita Tullio
- Institute of Hygiene and Clinical Epidemiology, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Alen Zabotti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
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Derfalvi B, Boros KK, Szabo D, Bozsaki G, Cseh A, Rudas G, Muller KE, Veres G. Joint involvement, disease activity and quality of life in pediatric Crohn's disease - a cross-sectional study. Pediatr Rheumatol Online J 2022; 20:6. [PMID: 35093127 PMCID: PMC8801094 DOI: 10.1186/s12969-022-00664-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Few published data describe how joint involvement, the most prevalent extraintestinal manifestation, affects quality of life (QoL) of children with Crohn's disease (CD). Arthritis and arthralgia rates in pediatric CD patients are reportedly 3-24% and 17-22%, respectively, but studies on pre-emptive and systematic screening of joint involvement with detailed musculoskeletal rheumatological exam are lacking. More detailed data collection on joint involvement improves our understanding of how arthropathy relates to disease activity and QoL measured by the Pediatric CD Activity Index (PCDAI) and IMPACT-III questionnaire. Our study aims were to assess joint involvement in pediatric CD and correlate it with the PCDAI and IMPACT-III. METHODS In this cross-sectional, observational study, a pediatric gastroenterologist assessed consecutively-seen pediatric CD patients at a tertiary care center. Patients were screened for prevalence of current and previous arthropathy, including arthritis, enthesitis and arthralgia. A single experienced pediatric rheumatologist evaluated detailed musculoskeletal history, joint status, and modified Juvenile Arthritis Multidimensional Assessment Reports (JAMAR). PCDAI, IMPACT-III, sacroiliac MRI, and HLA-B27 genetic testing were also completed. RESULTS A total of 82 (male:female, 1.2:1; age, 13.7 ± 3.2 years) patients were involved in this study. Mean disease duration at time of study was 21.6 ± 21 months; eight of the patients were newly-diagnosed. Of the 82 patients, 29 (35%) had evidence of arthritis; for 24 of those, this was revealed by physical exam during cross-sectional screening, and by prior documentation for the remaining five patients. Joint examination confirmed active arthritis in 8/24 (33%), active enthesitis in 1/24 (4%), and evidence of previous arthritis in 15/24 (62.5%) patients. Hip (41%) and knee (38%) joints were most commonly affected. Cumulative incidence of arthralgia was 48% (39/82), and 46% (18/39) of those patients had only arthralgia without arthritis, usually affecting the knee. Axial involvement was present in 10/82 (12%) patients. Joint involvement correlated with more severe CD disease activity, specifically higher PCDAI and lower IMPACT-III scores, and increased requirement for infliximab treatment. Sacroiliitis and HLA-B27 positivity were insignificant factors in this cohort. CONCLUSIONS When a rheumatologist performed the assessment, joint involvement in pediatric CD was more prevalent than previously reported, in this cross-sectional study. Arthritis was associated with more severe CD disease activity and lower QoL.
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Affiliation(s)
- Beata Derfalvi
- Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Kriszta Katinka Boros
- grid.11804.3c0000 0001 0942 98211st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Doloresz Szabo
- grid.11804.3c0000 0001 0942 98211st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Gabor Bozsaki
- grid.11804.3c0000 0001 0942 98211st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Aron Cseh
- grid.11804.3c0000 0001 0942 98211st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Gabor Rudas
- grid.11804.3c0000 0001 0942 9821MR Science Centre, Semmelweis University, Budapest, Hungary
| | - Katalin Eszter Muller
- grid.9679.10000 0001 0663 9479Institute for Translational Medicine, University of Pécs, Pécs, Hungary ,grid.413987.00000 0004 0573 5145Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Gabor Veres
- grid.7122.60000 0001 1088 8582Paediatric Institute, University of Debrecen, Debrecen, Hungary
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Ha YJ, Kim HJ, Lee E, Park JH, Park YS, Lee YJ, Kang Y, Yoon H. Subclinical sacroiliitis detected by abdominopelvic computed tomography in Korean patients with Crohn's disease. Korean J Intern Med 2021; 36:868-877. [PMID: 32872747 PMCID: PMC8273833 DOI: 10.3904/kjim.2020.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/03/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/AIMS Sacroiliitis is a frequent extraintestinal manifestation of inflammatory bowel diseases (IBDs). This study aimed to assess the prevalence of sacroiliitis using a validated screening tool based on abdominopelvic computed tomography (APCT) in Korean patients with Crohn's disease (CD) and examine potential associations between clinical characteristics and sacroiliitis. METHODS One hundred five patients with CD undergoing APCT for any indication at an IBD clinic were matched 1:1 for age and sex with 105 controls without underlying chronic illnesses. Using a validated APCT screening tool that defines sacroiliitis as either ankylosis or a total erosion score (TES) ≥ 3, all computed tomography scans were assessed by two independent, blinded radiologists. We compared the prevalence of sacroiliitis between CD patients and controls and clinical characteristics between CD patients with and without sacroiliitis. RESULTS The prevalence of sacroiliitis was significantly higher in CD patients than in controls (13.3% vs. 4.8%, p = 0.030). All subjects with sacroiliitis had a TES ≥ 3, but no ankylosis. The assessment of sacroiliitis in APCT showed excellent interreader reliability (Cohen's kappa = 0.933 for presence of sacroiliitis). Sacroiliitis in CD patients was bilateral and asymptomatic. There were no significant associations between sacroiliitis and any demographic data or clinical characteristics in these patients. CONCLUSION The prevalence of APCT-detected sacroiliitis in CD patients was higher than that in controls, but the condition was asymptomatic. The clinical significance of asymptomatic sacroiliitis in Korean CD patients remains unclear.
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Affiliation(s)
- You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyo Jin Kim
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Ji Hye Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
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10
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Märker-Hermann E. [Update: enterogenic spondylarthritis]. Z Rheumatol 2021; 80:539-551. [PMID: 34046687 DOI: 10.1007/s00393-021-01014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/30/2022]
Abstract
Spondylarthritis (SpA) is one of the most frequent extraintestinal manifestations of chronic inflammatory bowel disease (IBD). Several arthritogenic enterobacterial infections can induce sequelae such as reactive SpA. Studies on the gut-synovium axis in view of genetic, immunological, clinical and therapeutic aspects has made enterogenic SpA a model disease of all forms of SpA. The same applies for investigating IBD, as subclinical gut inflammation seen in SpA patients has provided significant evidence for a better understanding of mucosa-associated early immune events in Crohn's disease (CD). This article summarizes the pathognomonic clinical features, diagnostic steps, differential diagnosis and current pathogenetic models of enterogenic SpA. Knowledge of pathogenetic contexts leads to concrete treatment recommendations. These vary individually depending on the underlying IBD, on the inflammatory intestinal or rheumatic activity and on the rheumatological manifestation pattern.
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Affiliation(s)
- Elisabeth Märker-Hermann
- Klinik Innere Medizin IV Rheumatologie, klinische Immunologie und Nephrologie, Helios Dr. Horst Schmidt-Kliniken Wiesbaden, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland.
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11
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Levine I, Malik F, Castillo G, Jaros B, Alaia E, Ream J, Scher JU, Hudesman D, Axelrad J. Prevalence, Predictors, and Disease Activity of Sacroiliitis Among Patients with Crohn's Disease. Inflamm Bowel Dis 2021; 27:809-815. [PMID: 32793977 DOI: 10.1093/ibd/izaa198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sacroiliitis is an inflammatory arthritis of the sacroiliac joints and is associated with inflammatory bowel disease (IBD). Yet, sacroiliitis often goes undiagnosed in IBD, and the clinical association between IBD disease activity and sacroiliitis is not well established. Patients with Crohn's disease (CD) often receive magnetic resonance enterography (MRE) to assess disease activity, affording clinicians the opportunity to evaluate for the presence of sacroiliitis. We aimed to identify the prevalence and disease characteristics associated with sacroiliitis in CD patients undergoing MRE. METHODS All CD patients undergoing MRE for any indication between 2014 and 2018 at an IBD referral center were identified. The MREs were reviewed for the presence of sacroiliitis based on bone marrow edema (BME) and structural lesions. We analyzed demographics, IBD characteristics, clinical and endoscopic disease activity, and management between CD patients with and without sacroiliitis. RESULTS Two hundred fifty-eight patients with CD underwent MRE during the study period. Overall, 17% of patients had MR evidence of sacroiliitis, of whom 73% demonstrated bone marrow edema. Female gender, back pain, and later age of CD diagnosis were associated with sacroiliitis (P = 0.05, P < 0.001, P = 0.04, respectively). Disease location and CD therapy were not associated with sacroiliitis on MRE. Clinical, endoscopic, and radiographic disease activity were not associated with sacroiliitis on MRE. CONCLUSION Sacroiliitis is a common comorbid condition in CD. With limited clinical clues and disease characteristics to suggest sacroiliitis, physicians may utilize MRE to identify sacroiliitis, especially in CD patients with back pain.
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Affiliation(s)
- Irving Levine
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Fardina Malik
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - Gabriel Castillo
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Brian Jaros
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Erin Alaia
- NYU Langone Health, Department of Radiology, New York, NY, USA
| | - Justin Ream
- NYU Langone Health, Department of Radiology, New York, NY, USA
| | - Jose U Scher
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - David Hudesman
- NYU Langone Health, Department of Medicine, Division of Gastroenterology, New York, NY, USA
| | - Jordan Axelrad
- NYU Langone Health, Department of Medicine, Division of Gastroenterology, New York, NY, USA
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12
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Imaging in the Assessment of Musculoskeletal Manifestations Associated with Inflammatory Bowel Disease. GASTROENTEROLOGY INSIGHTS 2021. [DOI: 10.3390/gastroent12010010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Extraintestinal manifestations are the cause of morbidity and affect the quality of life of patients with inflammatory bowel diseases (IBDs). Musculoskeletal manifestations, in particular, spondyloarthritis and osteoporosis, are the most frequent extraintestinal manifestation of IBDs. The diagnosis and management of the musculoskeletal manifestation of IBDs relies on imaging. Conventional radiography, magnetic resonance imaging, computed tomography, and ultrasound can help to detect pathological signs of spondyloarthritis, both peripheral and with axial involvement. Dual-energy X-ray absorptiometry is the gold standard for identifying the presence of osteoporosis, whereas conventional radiology and computed tomography can reveal occult vertebral fractures. The aim of this narrative review is to describe the imaging of musculoskeletal manifestations of IBDs.
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13
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Evans J, Sapsford M, McDonald S, Poole K, Raine T, Jadon DR. Prevalence of axial spondyloarthritis in patients with inflammatory bowel disease using cross-sectional imaging: a systematic literature review. Ther Adv Musculoskelet Dis 2021; 13:1759720X21996973. [PMID: 33786068 PMCID: PMC7958176 DOI: 10.1177/1759720x21996973] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/01/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) have an excess burden of axial spondyloarthritis (axSpA), which, if left untreated, may significantly impact on clinical outcomes. We aimed to estimate the prevalence of axSpA, including previously undiagnosed cases, in IBD patients from studies involving cross-sectional imaging and identify the IBD features potentially associated with axSpA. METHODS PubMed, Embase and Cochrane databases were searched systematically between 1990 and 2018. Article reference lists and key conference abstract lists from 2012 to 2018 were also reviewed. All abstracts were reviewed by two authors to determine eligibility for inclusion. The study inclusion criteria were (a) adults aged 18 years or above, (b) a clinical diagnosis of IBD and (c) reporting identification of sacroiliitis using cross-sectional imaging. RESULTS A total of 20 observational studies were identified: 12 used CT, 6 used MR and 2 utilised both computed tomography (CT) and magnetic resonance (MR) imaging. Sample sizes ranged from 25 to 1247 (a total of 4096 patients); 31 studies were considered to have low selection bias, 13 included two or more radiology readers, and 3 included rheumatological assessments. The prevalence of sacroiliitis, the most commonly reported axSpA feature, ranged from 2.2% to 68.0% with a pooled prevalence of 21.0% [95% confidence interval (CI) 17-26%]. Associated IBD features include increasing IBD duration, increasing age, male sex, IBD location, inflammatory back pain and peripheral arthritis. No significant difference in the prevalence of sacroiliitis between Crohn's disease and ulcerative colitis was identified. Study limitations include variability in the individual study sample sizes and patient demographics. CONCLUSION This review highlights the need for larger, well-designed studies using more sensitive imaging modalities and multivariable modelling to better estimate the prevalence of axSpA in IBD. An improved knowledge of the IBD phenotype(s) associated with axSpA and use of cross-sectional imaging intended for IBD assessment to screen for axSpA may help clinicians identify those patients most at risk.
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Affiliation(s)
- Jobie Evans
- Department of Rheumatology, Cambridge University
Hospitals NHSFT, Hills Road, Cambridge, CB2 0QQ, UK
- Department of Medicine, University of Cambridge,
Cambridge, UK
| | - Mark Sapsford
- North Shore Hospital, Waitemata District Health
Board, Auckland, New Zealand
| | - Scott McDonald
- Department of Radiology, Cambridge University
Hospitals NHSFT, Cambridge, UK
| | - Kenneth Poole
- Department of Rheumatology, Cambridge University
Hospitals NHSFT, Cambridge, UK
- Department of Medicine, University of Cambridge,
Cambridge, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge
University Hospitals NHSFT, Cambridge, UK
| | - Deepak R. Jadon
- Department of Rheumatology, Cambridge University
Hospitals NHSFT, Cambridge, UK
- Department of Medicine, University of Cambridge,
Cambridge, UK
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14
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Deepak P, Ludwig DR, Fidler JL, Guglielmo FF, Bruining DH. Medical and Endoscopic Management of Crohn Disease. Top Magn Reson Imaging 2021; 30:43-61. [PMID: 33528211 DOI: 10.1097/rmr.0000000000000267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT In this review, through a series of questions and answers, we explore the current approach to classifying patients with Crohn disease into low-risk (mild-moderate) and high-risk (moderate-severe) categories with the recommended treatment approaches per guidelines from the International Organization for the Study of Inflammatory Bowel Diseases, American Gastroenterological Association, the American College of Gastroenterology, and the European Crohn's and Colitis Organization detailed here. The development pipeline of potential therapies is also summarized. We also review key information from magnetic resonance enterography and pelvis imaging studies that the abdominal radiologist can communicate to a multidisciplinary treatment team that includes gastroenterologists and colorectal surgeons, with a goal of achieving optimal patient outcomes. Lastly, endoscopic and radiological treatment targets in a treat-to-target approach in Crohn disease are explored.
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Affiliation(s)
- Parakkal Deepak
- Washington University Inflammatory Bowel Diseases Center, Division of Gastroenterology, Washington University in Saint Louis School of Medicine, St. Louis, MO
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
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15
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Takahashi H, Froemming AT, Bruining DH, Karnes RJ, Jimenez RE, Takahashi N. Prostate MRI characteristics in patients with inflammatory bowel disease. Eur J Radiol 2021; 135:109503. [PMID: 33418382 DOI: 10.1016/j.ejrad.2020.109503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous studies have indicated an increased risk of prostate carcinoma (PCa) associated with inflammatory bowel disease (IBD). Prostate MRI of IBD patients could be expected to show a mixture of inflammation as well as higher than normal rates of PCa, which could impact interpretation and MRI performance. The purpose of this study is to evaluate the characteristics of prostate MRI in patients with IBD. METHODS 3140 patients with prostate MRI were evaluated. Coexisting IBD, PI-RADS score, and pathological results of prostate lesions (clinically significant PCa [csPCa]: Gleason score [GS] 7+, Non-csPCa: benign or GS 6) were assessed. The distribution of PI-RADS scoring and pathological result was assessed by chi-square test. RESULTS 71 patients had IBD (IBD group), whereas the remaining 3069 patients did not (Non-IBD group). The proportion of abnormal MRI (PI-RADS 3, 4 or 5) was 51 % (36/71) in IBD group and 47 % (1436/3069) in Non-IBD groups (p = 0.513). Total of 1285 patients underwent biopsy or prostatectomy. The proportion of csPCa at pathology was 35 % (12/34) in IBD group and 56 % (699/1251) in non-IBD groups (p = 0.017). The positive predictive value of abnormal MRI for csPCa was significantly lower in IBD group (39 %, 19/31) compared to Non-IBD group (63 %, 657/1047) (p = 0.007). CONCLUSION The proportion of csPCa at pathology and positive predictive value of abnormal MR for csPCa were lower in patients with IBD group compared to Non-IBD group.
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Affiliation(s)
| | | | - David H Bruining
- Mayo Clinic, Department of Gastroenterology and Hepatology, Minnesota, USA
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16
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Inflammatory Bowel Diseases and Coexisting Spondyloarthritis: A Neglected and too Often Under-Reported Association by Radiologists. A Multicenter Study by Italian Research Group of Imaging in Rheumatology. GASTROENTEROLOGY INSIGHTS 2020. [DOI: 10.3390/gastroent11020008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the prevalence and the underreporting rate of sacroiliitis (SI) in a large cohort of patients with biopsy-proved Crohn’s disease (CD) who underwent magnetic resonance enterography (MRE) or computed tomography enterography (CTE). Materials and Methods: Patients with CD were recruited from eight Italian health centers in the period from January 2013 to December 2017. Disease activity was recorded according to the CD activity index (CDAI). The scans were read by two blinded readers who defined the presence of SI according to Assessment of SpondyloArthritis International Society (ASAS) classifications and European League Against Rheumatism (EULAR) recommendations. Moreover, SI was scored using a simplified Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. Results: Interobserver agreement in diagnosing SI on imaging was good (K = 0.72–0.83). SI was diagnosed in 129 (14.4%, 54 men, 75 women) out of 894 patients; however, sacroiliac joint (SIJ) abnormalities were not mentioned in the radiological reports of 112 patients (86%). Fifty (38.7%) out of 129 patients also underwent a subsequent SIJ evaluation through a dedicated MRI protocol to confirm SI. SI was found in a higher percentage of patients with “active” than “inactive” CD (18% vs. 4%). Conclusion: This study confirms the feasibility of CTE and MRE for the screening of SI in CD patients; however, it also underlines the remarkable problem concerning the underreporting of this entity in radiological practice.
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17
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Fauny M, Cohen N, Morizot C, Leclerc-Jacob S, Wendling D, Lux G, Laurent V, Blum A, Netter P, Baumann C, Chary-Valckenaere I, Peyrin-Biroulet L, Loeuille D. Low Back Pain and Sacroiliitis on Cross-Sectional Abdominal Imaging for Axial Spondyloarthritis Diagnosis in Inflammatory Bowel Diseases. Inflamm Intest Dis 2020; 5:124-131. [PMID: 32999885 DOI: 10.1159/000507930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background Joint damage is the most frequent extraintestinal manifestation in inflammatory bowel disease (IBD). Aims The aim of the study was to assess the value of low back pain (LBP) associated with sacroiliitis on abdominal imaging for the diagnosis of spondyloarthritis (SpA) in IBD. Methods We used a questionnaire assessing rheumatological symptoms for all patients with abdominal computed tomography (CT) and magnetic resonance enterography (MRE). Sacroiliitis was assessed on available CT and MRE. Patients were classified as axial SpA according to the Assessment of SpondyloArthritis International Society criteria. Results Fifty-one patients completed the questionnaire and performed both exams. LBP was present in 27 patients (52.9%), and 10 (19.6%) had an inflammatory component. Sacroiliitis was reported in 12 patients (23.5%), and 6 of them suffered from LBP. Among the 20 patients referred to the rheumatologist, 11 patients suffered from LBP. One patient was HLA-B27 positive and presented sacroiliitis. For the last 10 patients, none of them had a sacroiliitis, and 2 patients were negative for HLA-B27. Conclusion An axial SpA has been diagnosed in 11.8% of IBD patients undergoing cross-sectional imaging, whereas one-fifth had inflammatory LBP, and sacroiliitis was observed in one-quarter of them. To optimize the diagnosis of axial SpA, HLA-B27 testing might be required for patients with both IBD and LBP, but this will require further investigation before its implementation in routine practice.
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Affiliation(s)
- Marine Fauny
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Nicolas Cohen
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Caroline Morizot
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Sophie Leclerc-Jacob
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Daniel Wendling
- Department of Rheumatology, University Hospital of Besancon, Besancon, France
| | - Guillaume Lux
- Department of Radiology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Valérie Laurent
- Department of Radiology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Alain Blum
- Department of Radiology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Patrick Netter
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Cédric Baumann
- Unity of Methodology, Data Management and Statistic, University Hospital of Nancy, Nancy, France
| | - Isabelle Chary-Valckenaere
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France.,Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Hepatology, Inserm NGERE, University Hospital of Nancy, Lorraine University, Nancy, France.,Inserm U1256 NGERE, Lorraine University, Vandoeuvre-Les-Nancy, France
| | - Damien Loeuille
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France.,Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France
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18
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Benfaremo D, Luchetti MM, Di Carlo M, Laganà B, Picchianti-Diamanti A, Carubbi F, Pica R, Chimenti MS, Lorenzetti R, Scolieri P, Bruzzese V, Benedetti A, Ramonda R, Giacomelli R, Salaffi F, Gabrielli A. Multicenter Validation of the DETAIL Questionnaire for the Screening of Spondyloarthritis in Patients With Inflammatory Bowel Diseases. J Rheumatol 2020; 48:179-187. [PMID: 32669448 DOI: 10.3899/jrheum.200364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Spondyloarthritis (SpA) is among the most frequent extraintestinal manifestations of inflammatory bowel diseases (IBD). In this study, we aimed to validate the DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire in a multicenter cohort of patients with IBD enrolled at 11 gastroenterology units. METHODS From October 2018 to March 2019, consecutive adult patients with IBD, either Crohn disease or ulcerative colitis, independently filled out the DETAIL questionnaire in the outpatient waiting room. Within 2 weeks a blinded rheumatologist assessed all the patients, irrespective of the DETAIL results, and classified them to be affected or not by SpA. The performance of the questions was evaluated through Bayesian analysis. RESULTS Overall, 418 patients with IBD filled out the DETAIL questionnaire. Upon rheumatological evaluation, 102 (24.4%) patients received a diagnosis of SpA. Of the 6 questions, the best performances were found in question 6 [positive likelihood ratio (LR)+ 3.77], reporting inflammatory back pain at night, and in question 3 (LR+ 3.31), exploring Achilles enthesitis. The presence of back pain lasting > 3 months (LR+ 2.91), back pain with inflammatory features (LR+ 2.55), and a history of dactylitis (LR+ 2.55), also showed a fairly good performance, whereas a history of peripheral synovitis was slightly worse (LR+ 2.16). The combination of at least 3 questions answered affirmatively yielded a posttest probability of SpA of 80% or more. The presence of alternative diagnoses, such as osteoarthritis or fibromyalgia, represented a minor confounder. CONCLUSION The DETAIL questionnaire is a useful tool for the early detection of SpA in IBD.
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Affiliation(s)
- Devis Benfaremo
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Michele Maria Luchetti
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Marco Di Carlo
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Bruno Laganà
- B. Laganà, MD, A. Picchianti-Diamanti, MD, PhD, Department of Clinical and Molecular Medicine, S. Andrea University Hospital, "Sapienza" University, Rome
| | - Andrea Picchianti-Diamanti
- B. Laganà, MD, A. Picchianti-Diamanti, MD, PhD, Department of Clinical and Molecular Medicine, S. Andrea University Hospital, "Sapienza" University, Rome
| | - Francesco Carubbi
- F. Carubbi, MD, PhD, R. Giacomelli, MD, PhD, Rheumatology Unit, University Hospital "S. Salvatore", Department of Clinical and Biotechnologic Sciences, University of L'Aquila
| | - Roberta Pica
- R. Pica, MD, UOS Gastroenterologia Territoriale, ASL Roma 2, Rome
| | - Maria Sole Chimenti
- M.S. Chimenti, MD, UOC Reumatologia, Dipartimento di Medicina dei Sistemi, Università di Tor Vergata, Roma
| | - Roberto Lorenzetti
- R. Lorenzetti, MD, UOC Gastroenterologia, Polo Ospedaliero Nuovo Regina Margherita - S.Spirito, Rome
| | - Palma Scolieri
- P. Scolieri, MD, V. Bruzzese, MD, UOC Medicina Interna e Reumatologia, Polo Ospedaliero Nuovo Regina Margherita - S.Spirito, Rome
| | - Vincenzo Bruzzese
- P. Scolieri, MD, V. Bruzzese, MD, UOC Medicina Interna e Reumatologia, Polo Ospedaliero Nuovo Regina Margherita - S.Spirito, Rome
| | - Antonio Benedetti
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Roberta Ramonda
- R. Ramonda, MD, PhD, UOC di Reumatologia, Dipartimento di Medicina DIMED, Università di Padova, Italy
| | - Roberto Giacomelli
- F. Carubbi, MD, PhD, R. Giacomelli, MD, PhD, Rheumatology Unit, University Hospital "S. Salvatore", Department of Clinical and Biotechnologic Sciences, University of L'Aquila
| | - Fausto Salaffi
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Armando Gabrielli
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
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Giani T, Bernardini A, Basile M, Di Maurizo M, Perrone A, Renzo S, Filistrucchi V, Cimaz R, Lionetti P. Usefulness of magnetic resonance enterography in detecting signs of sacroiliitis in young patients with inflammatory bowel disease. Pediatr Rheumatol Online J 2020; 18:42. [PMID: 32493352 PMCID: PMC7268528 DOI: 10.1186/s12969-020-00433-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Arthritis is often an underestimated extraintestinal manifestation in pediatric inflammatory bowel disease (IBD), including sacroiliitis, whose early signs are well detectable at magnetic resonance imaging (MRI). Magnetic resonance enterography (MRE) is an accurate imaging modality for pediatric IBD assessment. We studied the possibility to detect signs of sacroiliac inflammation in a group of children with IBD who underwent MRE for gastrointestinal disease evaluation. METHODS We retrospectively reviewed MRE scans performed in pediatric patients with IBD. We looked for signs of sacroiliitis taking the ASAS (Assessment of SpondyloArthritis international Society) criteria as a model. Presence of bone marrow edema (using T2W sequences with fat suppression), diffusion restriction in Diffusion Weighted Imaging (DWI) or Diffusion Weighted Imaging with Background Suppression (DWIBS), and dynamic contrast enhancement were evaluated. Each SI joint was divided into 4 quadrants: upper iliac, lower iliac, upper sacral, and lower sacral. Two blinded observers with experience in pediatric and skeletal imaging independently evaluated the images. Cases upon which there was a disagreement were evaluated by the two reviewing radiologists and a third radiologist with similar experience together. RESULTS We enrolled 34 patients (24 males and 10 females, with mean age at scanning 14.3 years, median 15.3 years; 2 affected by ulcerative colitis, 32 by Crohn's disease) for a total of 59 examinations performed at the time of their first diagnosis or at symptom exacerbations. No patient complained of musculoskeletal symptoms, neither had pathological findings at articular examination. At the time of MRE 25 patients were under treatment for their IBD. Five patients had radiological signs of SI inflammation at MRE, albeit of mild degree. All patients with SI joint edema also had a restricted diffusion in DWIBS or DWI and almost everyone had contrast media uptake. CONCLUSIONS Sacroiliitis is one of the extraintestinal manifestation associated with IBD; it is often asymptomatic and clinically underdetected, with an unrelated progression with respect to the underlying IBD. MRE offers the possibility to study SI joints in young patients with IBD who undergo MRE for the investigation of their intestinal condition. Furthermore, we observed that gadolinium enhancement does not improve diagnostic specificity in sacroiliiitis detection.
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Affiliation(s)
- Teresa Giani
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy ,grid.9024.f0000 0004 1757 4641Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Azzurra Bernardini
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Massimo Basile
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Marco Di Maurizo
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Anna Perrone
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Sara Renzo
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Viola Filistrucchi
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health and Research Center for Adult and Rheumatic Diseases, University of Milan, Milan, Italy.
| | - Paolo Lionetti
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy ,grid.8404.80000 0004 1757 2304Neurofarba Department, University of Florence, Florence, Italy
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20
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Varkas G, Ribbens C, Louis E, Van den Bosch F, Lories R, Vermeire S, Elewaut D, De Vos M. Expert consensus: practical algorithms for management of inflammatory bowel disease patients presenting with back pain or peripheral arthropathies. Aliment Pharmacol Ther 2019; 50:1204-1213. [PMID: 31650573 DOI: 10.1111/apt.15519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/13/2019] [Accepted: 09/08/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Spondyloarthritis is the most frequent extra-intestinal manifestation of IBD. AIM To present simple strategies to identify and differentiate inflammatory joint pain in IBD patients. METHODS A panel of Belgian gastroenterologists and rheumatologists developed seven algorithms for IBD patients with joint symptoms based on a Delphi exercise conducted between April and December 2016. Here, we focus on referral strategies for patients with chronic back pain (evidence-based strategy), large joint monoarthritis, oligo- or polyarticular arthritis or arthralgia (based on expert opinion). We also present management tools for IBD patients with acute back pain and small joint monoarthritis (Supplementary file). RESULTS The reported algorithm for IBD patients with chronic back pain uses basic clinical criteria to identify which patients should be referred to the emergency room (spondylodiscitis), physical medicine and rehabilitation (mechanical back pain) or rheumatologist (spondyloarthritis). IBD patients with large joint monoarthritis should be referred to emergency room if septic arthritis is suspected; in other patients, blood analyses and referral to a rheumatologist for articular puncture with evacuation of synovial fluid are recommended. The analysis of synovial fluid allows for identification of non-inflammatory (e.g., osteoarthritis) and inflammatory (e.g., [pseudo]-gout, peripheral spondyloarthritis and Borrelia burgdorferi arthritis) conditions. In patients with inflammatory oligoarticular or polyarticular arthralgia, erythrocyte sedimentation rate, concomitant therapies, anti-nuclear factor and anti-double-stranded DNA antibody levels should be evaluated; in anti-tumour necrosis factor-treated patients, a drug-induced lupus-like syndrome should be considered. CONCLUSION We propose straightforward strategies for IBD patients with joint symptoms, which are specific enough to select initial treatment and referral pattern.
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Affiliation(s)
- Gaëlle Varkas
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,VIB Inflammation Research Center, Ghent University, Ghent, Belgium
| | - Clio Ribbens
- Department of Rheumatology, University of Liège, Liège, Belgium
| | - Edouard Louis
- Department of Hepato-Gastroenterology, CHU Liège, University of Liège, Liège, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,VIB Inflammation Research Center, Ghent University, Ghent, Belgium
| | - Rik Lories
- Laboratory of Tissue Homeostasis and Disease, Division of Rheumatology, Skeletal Biology and Engineering Research Center, University Hospitals Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders (TARGID), University Hospitals Leuven, Leuven, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,VIB Inflammation Research Center, Ghent University, Ghent, Belgium
| | - Martine De Vos
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
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21
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Biomarkers in Inflammatory Bowel Disease-Associated Spondyloarthritis: State of the Art and Unmet Needs. J Immunol Res 2019; 2019:8630871. [PMID: 31276001 PMCID: PMC6589275 DOI: 10.1155/2019/8630871] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/27/2019] [Indexed: 12/11/2022] Open
Abstract
Inflammatory bowel disease-associated spondyloarthritis is a systemic disease characterized by the chronic inflammation of both the gastrointestinal tract and the musculoskeletal system. Since inflammatory bowel disease-associated spondyloarthritis has been associated with a significant diagnostic delay, which may lead to poor quality of life and progression of joint damage, efforts to discover new reliable and noninvasive diagnostic biomarkers have been made. We reviewed the state of the art of biomarker research in inflammatory bowel disease-associated spondyloarthritis, showing that to date it has been largely unsatisfactory. Only a few of the biomarkers that have been investigated are likely to enter the clinical practice upon further validation in independent cohorts. The research of new and innovative biomarkers for inflammatory bowel disease-associated spondyloarthritis is warranted.
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Kelly OB, Li N, Smith M, Chan J, Inman RD, Silverberg MS. The Prevalence and Clinical Associations of Subclinical Sacroiliitis in Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1066-1071. [PMID: 30428061 DOI: 10.1093/ibd/izy339] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sacroiliitis, an inflammatory arthropathy associated with ankylosing spondylitis (AS), is found in patients with inflammatory bowel disease (IBD) but may go undiagnosed. The aims of this study were to assess prevalence of sacroiliitis in IBD and to determine association between clinical characteristics of IBD and sacroiliitis. METHODS Inflammatory bowel disease patients undergoing abdomino-pelvic computed tomography (CT) for any indication (2006-2015) were identified. Using standardized CT scoring, sacroiliitis was confirmed. Two blinded readers used a standardised model where presence of ankylosis or erosion score >3 indicated sacroiliitis. Inflammatory bowel disease scoring was blinded to the presence of sacroiliitis. Demographics, IBD characteristics, clinical activity (Harvey Bradshaw Index >4, Mayo >2, as denoted by attending physician), endoscopic activity (Simple Endoscopic Score for Crohn's Disease >4/Mayo subscore >1), and arthritis/extraintestinal manifestations (EIMS) were recorded. Comparisons were made between those with/without sacroiliitis. RESULTS Three hundred sixteen patients were included (50% male; 74% Crohn's disease [CD]). Computed tomography scoring identified 49 (16%) with sacroiliitis. Radiologists had reported sacroiliitis in 33% of these. Five patients had been to a spondylitis clinic. Thirty-three of 49 had abdominal x-rays; 64% of these fulfilled the imaging component of Modified New York criteria for AS. More than 5 sacroiliac erosions were associated with radiologist-reported sacroiliitis (P < 0.0001). There was no difference in prevalence between CD and ulcerative colitis. Sacroiliitis was associated with male sex (63.3% vs 47.9%; odds ratio [OR], 1.8; P = 0.04), known arthritis (41% vs 12%; OR, 4.7; P < 0.0001), pain as an IBD symptom (77.7% vs 56.9%; P = 0.03), and CD inflammatory phenotype (P = 0.01). Endoscopic activity, location, and extent were not associated. CONCLUSIONS Sacroiliitis is underdiagnosed in IBD and is associated with male sex, arthritis, and inflammatory CD. Data support targeted screening in at-risk patients.
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Affiliation(s)
- Orlaith B Kelly
- Zane Cohen Center for Digestive Disease, Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Nicole Li
- Zane Cohen Center for Digestive Disease, Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Michelle Smith
- Zane Cohen Center for Digestive Disease, Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Jonathan Chan
- Arthritis Centre of Excellence, Division of Rheumatology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert D Inman
- Arthritis Centre of Excellence, Division of Rheumatology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mark S Silverberg
- Zane Cohen Center for Digestive Disease, Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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23
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Annese V. A Review of Extraintestinal Manifestations and Complications of Inflammatory Bowel Disease. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:66-73. [PMID: 31080385 PMCID: PMC6503692 DOI: 10.4103/sjmms.sjmms_81_18] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Extraintestinal manifestations (EIMs) are common in inflammatory bowel disease (IBD), in both Crohn's disease and ulcerative colitis. Almost any organ system can be affected, including the musculoskeletal, dermatologic, renal, hepatopancreatobiliary, pulmonary and ocular systems. However, the musculoskeletal and dermatologic systems are the most commonly involved sites of manifestations. While some manifestations such as peripheral arthritis and erythema nodosum have an association with IBD activity, others such as axial arthropathy, pyoderma gangrenosum and primary sclerosing cholangitis have an independent disease course. This review provides a summary of the most common EIMs in IBD and their prevalence and management.
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Affiliation(s)
- Vito Annese
- Department of Gastroenterology, Valiant Clinic, Dubai, United Arab Emirates
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24
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Ushimaru S, Ichikawa D, Yazawa M, Suzuki T, Okada E, Koike J, Shibagaki Y. Tubulointerstitial Nephritis Associated with Enteritis and Sacroiliitis. Intern Med 2019; 58:79-84. [PMID: 30146576 PMCID: PMC6367097 DOI: 10.2169/internalmedicine.1255-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The association between sacroiliitis and tubulointerstitial nephritis has not been reported. A 28-year-old man with a history of clinically diagnosed ulcerative colitis (4 years earlier) and sacroiliitis (6 months earlier) developed renal dysfunction 9 months ago, which progressed thereafter. We diagnosed him with tubulointerstitial nephritis by a renal biopsy, for which we started steroid therapy. Subsequently, his renal dysfunction, sacroiliitis, and enteritis partially improved. A pathological analysis of the kidney and intestine revealed lymphocyte infiltration and non-caseating granuloma in both organs. The similarities in the pathological findings and treatment response suggested a pathogenetic association between tubulointerstitial nephritis, enteritis, and sacroiliitis.
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Affiliation(s)
- Shu Ushimaru
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Daisuke Ichikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Masahiko Yazawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Tomo Suzuki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Eri Okada
- Department of Nephrology, National Hospital Organization Chiba-East-Hospital, Japan
| | - Junki Koike
- Department of Pathology, Kawasaki Municipal Tama Hospital, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
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25
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Felice C, Leccese P, Scudeller L, Lubrano E, Cantini F, Castiglione F, Gionchetti P, Orlando A, Salvarani C, Scarpa R, Vecchi M, Olivieri I, Armuzzi A. Red flags for appropriate referral to the gastroenterologist and the rheumatologist of patients with inflammatory bowel disease and spondyloarthritis. Clin Exp Immunol 2018; 196:123-138. [PMID: 30554407 DOI: 10.1111/cei.13246] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 12/18/2022] Open
Abstract
Collaboration between gastroenterologists and rheumatologists is recommended for the correct management of patients with associated spondyloarthritis (SpA) and inflammatory bowel disease (IBD). We aimed to establish the appropriateness of several red flags for a prompt specialist referral. A systematic review of the literature was performed using the GRADE method to describe the prevalence of co-existing IBD-SpA and the diagnostic accuracy of red flags proposed by a steering committee. Then, a consensus among expert gastroenterologists and rheumatologists (10 in the steering committee and 13 in the expert panel) was obtained using the RAND method to confirm the appropriateness of each red flag as 'major' (one sufficient for patient referral) or 'minor' (at least three needed for patient referral) criteria for specialist referral. The review of the literature confirmed the high prevalence of co-existing IBD-SpA. Positive and negative predictive values of red flags were not calculated, given the lack of available data. A consensus among gastroenterology and rheumatology specialists was used to confirm the appropriateness of each red flag. Major criteria to refer patients with SpA to the gastroenterologist included: rectal bleeding, chronic abdominal pain, perianal fistula or abscess, chronic diarrhoea and nocturnal symptoms. Major criteria to refer patients with IBD to the rheumatologist included: chronic low back pain, dactylitis, enthesitis and pain/swelling of peripheral joints. Several major and minor red flags have been identified for the diagnosis of co-existing IBD-SpA. The use of red flags in routine clinical practice may avoid diagnostic delay and reduce clinic overload.
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Affiliation(s)
- C Felice
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Leccese
- Rheumatology Institute of Lucania (IRel) and the Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera
| | - L Scudeller
- Clinical Epidemiology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - E Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute 'Vincenzo Tiberio', Università degli Studi del Molise, Campobasso, Italy
| | - F Cantini
- Division of Rheumatology, Hospital of Prato, Italy
| | - F Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - P Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - A Orlando
- IBD Unit, A.O. Ospedali Riuniti 'Villa Sofia-Cervello', Palermo, Italy
| | - C Salvarani
- Azienda USL - IRCCS di Reggio Emilia e, Università di Modena e Reggio Emilia, Italy
| | - R Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - M Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Organ Transplantation, University of Milan, Italy
| | - I Olivieri
- Rheumatology Institute of Lucania (IRel) and the Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera
| | - A Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
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26
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Chan J, Sari I, Salonen D, Silverberg MS, Haroon N, Inman RD. Prevalence of Sacroiliitis in Inflammatory Bowel Disease Using a Standardized Computed Tomography Scoring System. Arthritis Care Res (Hoboken) 2018; 70:807-810. [DOI: 10.1002/acr.23323] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/11/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Jonathan Chan
- Toronto Western Hospital; University of Toronto, Toronto, Ontario, Canada; and University of British Columbia; Vancouver British Columbia Canada
| | - Ismail Sari
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada; and Dokuz Eylul University School of Medicine; Izmir Turkey
| | | | - Mark S. Silverberg
- Zane Cohen Centre for Digestive Diseases; Mount Sinai Hospital; and University of Toronto; Toronto Ontario Canada
| | - Nigil Haroon
- Toronto Western Hospital and University of Toronto; Toronto Ontario Canada
| | - Robert D. Inman
- Toronto Western Hospital and University of Toronto; Toronto Ontario Canada
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27
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Tadbiri S, Peyrin-Biroulet L, Serrero M, Filippi J, Pariente B, Roblin X, Buisson A, Stefanescu C, Trang-Poisson C, Altwegg R, Marteau P, Vaysse T, Bourrier A, Nancey S, Laharie D, Allez M, Savoye G, Gilletta C, Gagniere C, Vuitton L, Viennot S, Aubourg A, Pelletier AL, Bouguen G, Abitbol V, Fumery M, Claudepierre P, Bouhnik Y, Amiot A. Impact of vedolizumab therapy on extra-intestinal manifestations in patients with inflammatory bowel disease: a multicentre cohort study nested in the OBSERV-IBD cohort. Aliment Pharmacol Ther 2018; 47:485-493. [PMID: 29250803 DOI: 10.1111/apt.14419] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 08/26/2017] [Accepted: 10/26/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effectiveness of vedolizumab as a treatment for extraintestinal manifestations (EIM) is questionable due to its gut-specificity. AIM To assess effectiveness of vedolizumab for EIM in patients with inflammatory bowel disease (IBD) in a large real-life experience cohort. METHODS Between June and December 2014, 173 patients with Crohn's disease and 121 with ulcerative colitis were treated with vedolizumab. Patients were followed until week 54. EIM activity was assessed at weeks 0, 6, 14, 22, 30 and 54 by using a 3-step scale: complete remission, partial response and no response. RESULTS At baseline, 49 (16.7%) patients had EIMs of which 47 had inflammatory arthralgia/arthritis, four had cutaneous lesions and two had both rheumatologic and skin EIM. At week 54, 21 (44.7%) patients had complete remission for inflammatory arthralgia/arthritis and three (75%) for cutaneous EIM. In multivariate analysis, complete remission of inflammatory arthralgia/arthritis was associated with clinical remission of IBD (OR = 1.89, IC95% [1.05-3.41], P = .03) and recent onset of inflammatory arthralgia/arthritis (OR = 1.99, IC95% [1.12-3.52], P = .02). During the follow-up period, 34 (13.8%) patients without any EIM at baseline, developed incident cases of inflammatory arthralgia/arthritis consisting mostly of peripheral arthralgia without evidence of arthritis and 14 (4.8%) incident cases of paradoxical skin manifestation. CONCLUSION Vedolizumab therapy is commonly associated with improvement in EIM. This was associated with quiescent IBD and recent EIM. However, paradoxical skin manifestation and inflammatory arthralgia/arthritis may occur upon vedolizumab therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - P Marteau
- Lariboisière hospital, Paris, France
| | | | | | | | | | - M Allez
- Saint Louis hospital, Paris, France
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28
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Ossum AM, Palm Ø, Lunder AK, Cvancarova M, Banitalebi H, Negård A, Høie O, Henriksen M, Moum BA, Høivik ML. Ankylosing Spondylitis and Axial Spondyloarthritis in Patients With Long-term Inflammatory Bowel Disease: Results From 20 Years of Follow-up in the IBSEN Study. J Crohns Colitis 2018; 12:96-104. [PMID: 28961700 DOI: 10.1093/ecco-jcc/jjx126] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with inflammatory bowel disease [IBD] often suffer from rheumatic manifestations, including inflammatory back disorders. The prevalence of these disorders late in the course of IBD is poorly investigated. The aim of this study was to estimate the prevalence of inflammatory back disorders in patients with IBD 20 years after diagnosis, and to investigate possible associations with IBD severity, HLA-B27, and the NOD2 genotype. METHODS A population-based cohort [the IBSEN study] was followed prospectively for 20 years. Information covering IBD activity and rheumatic diseases was collected at the regular follow-ups. HLA-B27 and NOD2 were analysed as present or absent. RESULTS At 20 years, 599 members of the original cohort were alive, of whom 470 [78.5%] were investigated [314 ulcerative colitis and 156 Crohn's disease patients]. Ankylosing spondylitis was diagnosed in 21 patients [4.5%], axial spondyloarthritis was diagnosed in 36 patients [7.7%], and inflammatory back pain was diagnosed in 54 patients [11.5%]. Chronic back pain [back pain > 3 months] was present in 220 patients [46.8%]. HLA-B27 was associated with ankylosing spondylitis, axial spondyloarthritis, and inflammatory back pain, whereas no significant association was found for NOD2. A more chronic IBD course was associated with axial spondyloarthritis. CONCLUSIONS Our data revealed a high prevalence of ankylosing spondylitis, axial spondyloarthritis, and inflammatory back pain 20 years after the IBD diagnosis. HLA-B27 but not NOD-2 was a predisposing factor for the inflammatory back disorders in IBD patients. Axial spondyloarthritis was associated with a more chronic active IBD disease course.
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Affiliation(s)
- Alvilde M Ossum
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Palm
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Aida Kapic Lunder
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Diagnostic Imaging, Akershus University Hospital, Oslo, Norway
| | - Milada Cvancarova
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.,Faculty of Public Health, Oslo and Akershus University College, Oslo, Norway
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Oslo, Norway
| | - Anne Negård
- Department of Diagnostic Imaging, Akershus University Hospital, Oslo, Norway
| | - Ole Høie
- Sørlandet Hospital, Department of Internal Medicine, Arendal, Norway
| | | | - Bjørn A Moum
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marte Lie Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
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29
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Pouillon L, Bossuyt P, Vanderstukken J, Moulin D, Netter P, Danese S, Jouzeau JY, Loeuille D, Peyrin-Biroulet L. Management of patients with inflammatory bowel disease and spondyloarthritis. Expert Rev Clin Pharmacol 2017; 10:1363-1374. [PMID: 28879780 DOI: 10.1080/17512433.2017.1377609] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION More than half of the patients with inflammatory bowel disease (IBD) experience at least one extra-intestinal manifestation (EIM). The most common EIM in patients with IBD is spondyloarthritis (SpA). Microscopic intestinal inflammation is documented in almost 50% of the patients with SpA. Areas covered: We give an overview of the classification, the epidemiology and the diagnosis of IBD and SpA. The treatment goals, the pharmacologic management options and the available treatment guidelines in IBD patients with SpA are discussed. Expert commentary: The coexistence of IBD and SpA generates challenges and opportunities for both the gastroenterologist and the rheumatologist. The potential of drugs with a gut-specific mode of action in the treatment of IBD-related arthritis warrants further exploration.
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Affiliation(s)
- Lieven Pouillon
- a Department of Hepato-Gastroenterology , University Hospital Leuven , Leuven , Belgium
| | - Peter Bossuyt
- b Imelda GI Clinical Research Centre , Imeldaziekenhuis Bonheiden , Bonheiden , Belgium
| | - Joke Vanderstukken
- c Department of Immunology-Allergology-Rheumatology , University Hospital Antwerp , Edegem , Belgium
| | - David Moulin
- d UMR 7365 IMoPA CNRS-Université de Lorraine , Biopôle de l'Université de Lorraine, Campus Biologie-Santé , Vandœuvre-lès-Nancy , France
| | - Patrick Netter
- d UMR 7365 IMoPA CNRS-Université de Lorraine , Biopôle de l'Université de Lorraine, Campus Biologie-Santé , Vandœuvre-lès-Nancy , France
| | - Silvio Danese
- e Department of Biomedical Sciences , Humanitas University , Rozzano , Milan , Italy
| | - Jean-Yves Jouzeau
- d UMR 7365 IMoPA CNRS-Université de Lorraine , Biopôle de l'Université de Lorraine, Campus Biologie-Santé , Vandœuvre-lès-Nancy , France
| | - Damien Loeuille
- f Department of Rheumatology , Nancy University Hospital, Université de Lorraine , Vandœuvre-lès-Nancy , France
| | - Laurent Peyrin-Biroulet
- g Inserm U954 and Department of Gastroenterology , Nancy University Hospital, Université de Lorraine , Vandœuvre-lès-Nancy , France
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30
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Yamamoto-Furusho JK, Sarmiento-Aguilar A. Joint involvement in Mexican patients with ulcerative colitis: a hospital-based retrospective study. Clin Rheumatol 2017; 37:677-682. [PMID: 28914369 DOI: 10.1007/s10067-017-3834-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 12/24/2022]
Abstract
The most frequent extra-intestinal manifestation in ulcerative colitis (UC) around the world is joint involvement. There are no previous data in Latin America that is about this aspect of disease; hence, the aim of this study was to determine the frequency and factors associated to joint involvement in Mexican patients with UC. A total of 295 patients with histological diagnosis of UC were studied, divided into two groups: (1) 154 cases with at least one joint affection (arthralgia, peripheral, or axial arthropathy (sacroilitis (SI) or ankylosing spondylitis (AS))) and (2) 141 controls that had never presented any joint involvement during the clinical course of UC. Demographic, clinical, and laboratory variables were collected from the clinical records, at the time of presentation of the joint involvement for the cases and with the last information available for controls. A total of 52.2% of the patients had joint involvement, which was also the most frequent extra-intestinal manifestation (EIM). The frequency of peripheral arthralgia was 46.8% and of axial arthropathy was 5.4% (2.7% AS, 2.4% SI, and 0.3% both). The female gender (P = 0.01, OR = 3.061 95% CI: 1.311-7.15), elevated erythrocyte sedimentation rate (ESR) (P = 0.07, OR = 8.04 95% CI: 1.759-36.764), and moderate disease activity by Truelove and Witts criteria (P = 0.024, OR = 4.37 95% CI: 1.211-15.78) were factors associated at the time of presentation of the joint affection. Joint involvement is the most frequent EIM in Mexican patients with UC. The female gender, elevated ESR, and disease activity are factors associated with its presentation.
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Affiliation(s)
- Jesús K Yamamoto-Furusho
- Inflammatory Bowel Disease Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Tlalpan, 14000, Mexico City, CP, Mexico.
| | - Andrea Sarmiento-Aguilar
- Inflammatory Bowel Disease Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Tlalpan, 14000, Mexico City, CP, Mexico
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31
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Karreman MC, Luime JJ, Hazes JMW, Weel AEAM. The Prevalence and Incidence of Axial and Peripheral Spondyloarthritis in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis 2017; 11:631-642. [PMID: 28453761 DOI: 10.1093/ecco-jcc/jjw199] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/02/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease [IBD] is a chronic disease which affects up to 0.5% of the population. Various extraintestinal manifestations occur, among which are rheumatic manifestations, grouped together under the name spondyloarthritis. The objective of this systematic review and meta-analysis was to give a systematic overview of the prevalence and incidence of spondyloarthritis in patients with inflammatory bowel disease. METHODS We systematically searched Embase, Pubmed, OvidSP, Scopus, and Web-of-Science databases from inception to August 2016. All articles that addressed the prevalence or incidence of the different features of spondyloarthritis in adult inflammatory bowel disease patients were included. Methodological quality was assessed using a modified quality assessment tool developed for prevalence studies. RESULTS A total of 71 studies were included, reporting on the prevalence of sacroiliitis, ankylosing spondylitis, arthritis, enthesitis, and dactylitis. Pooled prevalences were calculated for sacroiliitis (10%; 95% confidence interval [CI] 8-12%), ankylosing spondylitis [3%; 95% CI 2-4%], and arthritis [13%; 95% CI 12-15%]. Geographical area, setting and use of different criteria contribute to the large heterogeneity. Few estimates were available for enthesitis [prevalence range from 1% to 54%] and dactylitis [prevalence range from 0% to 6%]. Only three incidence studies were identified, which report cumulative incidences from 5 to 30 years. CONCLUSIONS Spondyloarthritis occurs in up to 13% of patients with IBD. Ankylosing spondylitis is the least common [3%] followed by sacroiliitis [10%] and peripheral arthritis [13%].
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Affiliation(s)
- Maren C Karreman
- Erasmus University Medical Center, Wytemaweg 80, Rotterdam, The Netherlands
- Maasstad Hospital, Maasstadweg 21, Rotterdam, The Netherlands
| | - Jolanda J Luime
- Erasmus University Medical Center, Wytemaweg 80, Rotterdam, The Netherlands
| | - Johanna M W Hazes
- Erasmus University Medical Center, Wytemaweg 80, Rotterdam, The Netherlands
| | - Angelique E A M Weel
- Erasmus University Medical Center, Wytemaweg 80, Rotterdam, The Netherlands
- Maasstad Hospital, Maasstadweg 21, Rotterdam, The Netherlands
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32
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Akkoc N, Khan MA. ASAS classification criteria for axial spondyloarthritis: time to modify. Clin Rheumatol 2016; 35:1415-23. [PMID: 27094940 DOI: 10.1007/s10067-016-3261-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 01/17/2023]
Abstract
The relationship between ankylosing spondylitis and the recently proposed entity called axial spondyloarthritis with its radiographic and non-radiographic forms that have been defined by the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial spondyloarthritis (axSpA), is currently being debated. The Food and Drug Agency (FDA) had criticized the ASAS criteria and the studies which used these criteria to enroll patients in a clinical trial of certolizumab and adalimumab for the treatment of non-radiographic axial spondyloarthritis. The primary aim of classification criteria is to create homogenous patient populations for basic and clinical research. But the multi-arm construct of the ASAS criteria is a potential source of heterogeneity reducing their utility. Criteria sets should be regarded as dynamic concepts open to modifications or updates as our knowledge advances. We provide evidence to conclude that it is time to modify the ASAS Criteria for axSpA, and we propose some of the steps that can be taken to start moving forward in improving the validity of these criteria.
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Affiliation(s)
- Nurullah Akkoc
- Department of Rheumatology, Faculty of Medicine, Dokuz Eylul University, Balcova, 35340, Izmir, Turkey
| | - Muhammad A Khan
- Case Western Reserve University, Cleveland, OH, USA.
- MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
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33
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Owlia MB, Danesh-Ardakani M. Frequency of sacroiliitis among patients with low back pain. Electron Physician 2016; 8:2094-100. [PMID: 27123217 PMCID: PMC4844474 DOI: 10.19082/2094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/24/2016] [Indexed: 01/27/2023] Open
Abstract
Introduction Sacroiliitis is one of the important symptoms in patients attending infectious diseases and rheumatology clinics. Some patients with sacroiliitis are asymptomatic, and some have unspecific symptoms. The aim of this study was to determine the frequency of sacroiliitis causes among patients attending Shahid Sadoughi’s infectious disease and rheumatology clinics. Methods In this study, we evaluated patients attending Shahid Sadoughi rheumatology and infectious diseases clinic in 2014. Patients who had positive findings in favor of sacroiliitis were evaluated by history, physical exam, laboratory tests, and imaging. The patients were divided into infectious, inflammatory non-infectious, and degenerative causes. The data were analyzed by IBM SPSS version 20 using the independent samples t-test, ANOVA, the chi-squared test, and the Fisher’s exact test. Results We studied 136 patients. Among them 64 (47.1%) were male, and 72 (52.9%) were female. The mean age of the participants was 34.28 ± 10.36 years. Among the patients, 12 (8.8%) had infectious causes, 120 (88.2%) had inflammatory non-infectious causes, and four (2.9%) had degenerative causes. Conclusion Based on our results, inflammatory non-infectious causes are at the top of the list of sacroiliitis causes, but we should always consider infectious causes, including brucellosis.
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Affiliation(s)
- Mohammad Bagher Owlia
- M.D., Full Professor of rheumatology, Department of Rheumatology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mitra Danesh-Ardakani
- M.D., Infectious Diseases Specialist, Department of Infectious Diseases, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Looking into the new ASAS classification criteria for axial spondyloarthritis through the other side of the glass. Curr Rheumatol Rep 2016; 17:515. [PMID: 25921789 DOI: 10.1007/s11926-015-0515-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The new concept of axial spondylitis (axSpA) and the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA have induced new clinical research that has broadened our understanding of spondyloarthritis (SpA) and has had indeed a positive impact on earlier diagnosis and treatment of patients with axSpA who have not yet developed radiographic sacroiliitis. The primary goal of any valid classification criteria for any disease is to provide a homogeneous study population with a common etiopathogenesis, similar prognosis, and similar response to identical treatment. Without such a homogeneous study population, robust clinical and basic science research in any subtype of SpA is not possible. All criteria are dynamic concepts that need updating as our knowledge advances and our review of the ASAS classification criteria of axSpA indicates that complex multi-selection design and unclear (not mutually exclusive) definitions of the imaging and clinical arms of the criteria results in patient heterogeneity across study populations. Therefore, there is a need to improve the validity of the ASAS criteria for axSpA. It is our opinion that in the meantime, the clinically well-established entity of AS, as defined by the modified New York (mNY) criteria, should be preserved for the most accurate comparison of the new research studies with those conducted over the last three decades, and that the use of the ASAS criteria should be restricted to patients with nr-axSpA, who are not recognized by the mNY criteria.
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Rheumatic manifestations in inflammatory bowel diseases: a link between GI and rheumatology. Clin Rheumatol 2015; 35:291-6. [DOI: 10.1007/s10067-015-3116-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 11/08/2015] [Indexed: 12/18/2022]
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Subramaniam K, Tymms K, Shadbolt B, Pavli P. Spondyloarthropathy in inflammatory bowel disease patients on TNF inhibitors. Intern Med J 2015; 45:1154-60. [DOI: 10.1111/imj.12891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/16/2015] [Indexed: 01/05/2023]
Affiliation(s)
- K. Subramaniam
- Gastroenterology and Hepatology Unit; Canberra Hospital; Canberra Australian Capital Territory Australia
- Australian National University Medical School; Canberra Australian Capital Territory Australia
| | - K. Tymms
- Australian National University Medical School; Canberra Australian Capital Territory Australia
- Rheumatology Department; Canberra Hospital; Canberra Australian Capital Territory Australia
| | - B. Shadbolt
- Australian National University Medical School; Canberra Australian Capital Territory Australia
- Centre for Advances in Epidemiology and Information Technology; Canberra Hospital; Canberra Australian Capital Territory Australia
| | - P. Pavli
- Gastroenterology and Hepatology Unit; Canberra Hospital; Canberra Australian Capital Territory Australia
- Australian National University Medical School; Canberra Australian Capital Territory Australia
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Bandinelli F, Manetti M, Ibba-Manneschi L. Occult spondyloarthritis in inflammatory bowel disease. Clin Rheumatol 2015; 35:281-9. [PMID: 26354428 DOI: 10.1007/s10067-015-3074-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 01/06/2023]
Abstract
Spondyloarthritis (SpA) is a frequent extra-intestinal manifestation in patients with inflammatory bowel disease (IBD), although its real diffusion is commonly considered underestimated. Abnormalities in the microbioma and genetic predisposition have been implicated in the link between bowel and joint inflammation. Otherwise, up to date, pathogenetic mechanisms are still largely unknown and the exact influence of the bowel activity on rheumatic manifestations is not clearly explained. Due to evidence-based results of clinical studies, the interest on clinically asymptomatic SpA in IBD patients increased in the last few years. Actually, occult enthesitis and sacroiliitis are discovered in high percentages of IBD patients by different imaging techniques, mainly enthesis ultrasound (US) and sacroiliac joint X-ray examinations. Several diagnostic approaches and biomarkers have been proposed in an attempt to correctly classify and diagnose clinically occult joint manifestations and to define clusters of risk for patient screening, although definitive results are still lacking. The correct recognition of occult SpA in IBD requires an integrated multidisciplinary approach in order to identify common diagnostic and therapeutic strategies. The use of inexpensive and rapid imaging techniques, such as US and X-ray, should be routinely included in daily clinical practice and trials to correctly evaluate occult SpA, thus preventing future disability and worsening of quality of life in IBD patients.
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Affiliation(s)
- Francesca Bandinelli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Mirko Manetti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Lidia Ibba-Manneschi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Extraintestinal manifestations in inflammatory bowel disease: Prevalence and predictors in Indian patients. Indian J Gastroenterol 2015; 34:387-94. [PMID: 26614005 DOI: 10.1007/s12664-015-0598-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/14/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is a paucity of reports on extraintestinal manifestations (EIMs) in patients with inflammatory bowel diseases (IBD) from Asia and India. METHODS From May 2011 to October 2012, consecutive IBD patients underwent a detailed history and physical examination, also by trained rheumatologist, dermatologist, and ophthalmologist, about whether they experienced any EIM at the time of inclusion or in the past. The disease phenotype/severity and location was classified according to the Montréal classification. All underwent magnetic resonance imaging (MRI) of sacroiliac joints, liver function test (LFT), transabdominal ultrasound, and dual energy X-ray absorptiometry (DEXA) scanning at neck femur (bilateral) and L4-L5 spine. RESULTS One hundred twenty patients were analyzed, 62 had Crohn's disease (CD) and 58 had ulcerative colitis (UC). Thirty-eight percent had at least one while 20% suffered from multiple EIMs. Except for uveitis and episcleritis, the frequency of individual EIMs did not differ between CD and UC patients. Twenty-three percent had peripheral arthritis, 18% had ankylosing spondylitis, and 13% had ophthalmological manifestations. Mucocutaneous manifestations, aphthous stomatitis and pyoderma gangrenosum (PG), were seen in 9%. None had erythema nodosum (EN) or primary sclerosing cholangitis (PSC). Fifty percent of patients had either osteopenia or osteoporosis on DEXA. Multivariable analysis revealed female gender, Hindu religion, severe disease, and steroid usage were significantly associated with the presence of EIMs. CONCLUSION The prevalence of EIM is similar to that reported from Europe and USA, albeit higher than that previously reported in Asian patients. Female sex, religion, severe disease, and steroid use were associated with EIM.
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Gotler J, Amitai MM, Lidar M, Aharoni D, Flusser G, Eshed I. Utilizing MR enterography for detection of sacroiliitis in patients with inflammatory bowel disease. J Magn Reson Imaging 2014; 42:121-7. [DOI: 10.1002/jmri.24762] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/03/2014] [Indexed: 01/08/2023] Open
Affiliation(s)
- Jakob Gotler
- Department of Diagnostic Imaging; Kaplan Medical Center; Rehovot Israel
| | - Michal M. Amitai
- Department of Diagnostic Imaging; Sheba Medical Center, Tel Hashomer, Sackler School of Medicine; Tel Aviv Israel
| | - Merav Lidar
- The Rheumatology Unit; Sheba Medical Center, Tel Hashomer, Sackler School of Medicine; Tel Aviv Israel
| | - Dvora Aharoni
- Department of Diagnostic Imaging; Sheba Medical Center, Tel Hashomer, Sackler School of Medicine; Tel Aviv Israel
| | - Gideon Flusser
- Department of Diagnostic Imaging; Sourasky Medical Center; Tel Aviv Israel
| | - Iris Eshed
- Department of Diagnostic Imaging; Sheba Medical Center, Tel Hashomer, Sackler School of Medicine; Tel Aviv Israel
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