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Falloon K, Dossaji Z, Mude P, Abushamma S, Ananthakrishnan A, Barnes EL, Bhalla J, Bhattacharya A, Cheemalavagu S, Colombel JF, Cross RK, Ermann J, Ha C, Herfarth H, Horst S, Hou J, Husni ME, Kline TM, Kuhn KA, Long MD, Loftus EV, Lukin DJ, Patel A, Rubin DT, Scherl EJ, Shah SA, Siaton BC, Sleiman J, Qazi T, Weisman MH, Cohen BL, Feagan BG, Rieder F. Diagnosis of Inflammatory Bowel Disease-Associated Peripheral Arthritis: A Systematic Review. Inflamm Bowel Dis 2025; 31:812-842. [PMID: 38836521 DOI: 10.1093/ibd/izae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Inflammatory bowel disease (IBD)-associated peripheral spondyloarthritis (pSpA) decreases quality of life and remains poorly understood. Given the prevalence of this condition and its negative impact, it is surprising that evidence-based disease definitions and diagnostic strategies are lacking. This systematic review summarizes available data to facilitate development and validation of diagnostics, patient-reported outcomes, and imaging indices specific to this condition. METHODS A literature search was conducted. Consensus or classification criteria, case series, cross-sectional studies, cohort studies, and randomized controlled trials related to diagnosis were included. RESULTS A total of 44 studies reporting data on approximately 1500 patients with pSpA were eligible for analysis. Data quality across studies was only graded as fair to good. Due to large heterogeneity, meta-analysis was not possible. The majority of studies incorporated patient-reported outcomes and a physical examination. A total of 13 studies proposed or validated screening tools, consensus, classification, or consensus criteria. A total of 28 studies assessed the role of laboratory tests, none of which were considered sufficiently accurate for use in diagnosis. A total of 17 studies assessed the role of imaging, with the available literature insufficient to fully endorse any imaging modality as a robust diagnostic tool. CONCLUSIONS This review highlights existing inconsistency and lack of a clear diagnostic approach for IBD-associated pSpA. Given the absence of an evidence-based approach, a combination of existing criteria and physician assessment should be utilized. To address this issue comprehensively, our future efforts will be directed toward pursuit of a multidisciplinary approach aimed at standardizing evaluation and diagnosis of IBD-associated pSpA.
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Affiliation(s)
- Katherine Falloon
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Zahra Dossaji
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Pooja Mude
- Department of Gastroenterology, Ascension Providence, Southfield, MI, USA
| | - Suha Abushamma
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | | | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Jaideep Bhalla
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Shashank Cheemalavagu
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joerg Ermann
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christina Ha
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Hans Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Sara Horst
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason Hou
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - M Elaine Husni
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Theresa M Kline
- Cleveland Clinic Foundation, Cleveland Clinic Library, Cleveland, OH, USA
| | - Kristine A Kuhn
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Dana J Lukin
- Department of Gastroenterology and Hepatology, Weill Cornell Medical Center, NY, NY, USA
| | - Aditi Patel
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David T Rubin
- Department of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Ellen J Scherl
- Department of Gastroenterology and Hepatology, Weill Cornell Medical Center, NY, NY, USA
| | - Samir A Shah
- Department of Gastroenterology, Brown University, Providence, RI, USA
| | - Bernadette C Siaton
- Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph Sleiman
- Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Taha Qazi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Michael H Weisman
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Brian G Feagan
- Division of Gastroenterology, Department of Medicine, Western University, London, ON, Canada
- Alimentiv Inc., London, ON, Canada
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
- Cleveland Clinic Program for Global Translational Inflammatory Bowel Disease, Cleveland Clinic, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, OH, USA
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Song K, Satsangi J, Coates LC. Arthritis complicating inflammatory bowel disease- the future is now. THE LANCET. RHEUMATOLOGY 2024; 6:e805-e810. [PMID: 39032495 DOI: 10.1016/s2665-9913(24)00132-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 07/23/2024]
Abstract
Fundamental advances are occurring across immune-mediated inflammatory diseases. Recent therapeutic developments include strategies to prevent rheumatoid arthritis in high-risk individuals, using baseline cellular immunophenotypes to predict response to biologics in psoriatic arthritis, and using biologics in a top-down approach for Crohn's disease. However, meaningful progress has not occurred in the management of patients with spondyloarthropathy complicating inflammatory bowel disease (IBD). Currently, the pathophysiology of IBD-related spondyloarthropathy is poorly understood; moreover, there are no accepted or disease-specific screening tools, diagnostic criteria, or licenced treatments. Current approaches to clinical care from rheumatologists and gastroenterologists largely involve the extrapolation of spondyloarthropathy and IBD clinical guidelines, respectively, despite increasing recognition of IBD-related spondyloarthropathy being its own entity, with a unique phenotype. There is an obvious contrast between spondyloarthropathy complicating IBD and the management of arthropathy complicating psoriasis, a disease area where defined diagnostic criteria and dedicated clinical trials allow clear management guidelines. We argue that the time has come for a parallel approach and dedicated focus on IBD-related spondyloarthropathy.
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Affiliation(s)
- Kaiyang Song
- Medical Sciences Division, University of Oxford, Oxford, UK.
| | - Jack Satsangi
- Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Vladimirova N, Terslev L, Attauabi M, Madsen G, Fana V, Wiell C, Døhn UM, Bendtsen F, Seidelin J, Burisch J, Østergaard M. Peripheral Joint and Enthesis Involvement in Patients With Newly Diagnosed Inflammatory Bowel Disease: Symptoms, and Clinical and Ultrasound Findings - A Population-Based Cohort Study. J Crohns Colitis 2024; 18:1053-1070. [PMID: 38366120 DOI: 10.1093/ecco-jcc/jjae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES Musculoskeletal [MSK] manifestations in patients with inflammatory bowel disease [IBD] are common and associated with poorer outcomes. Hence, early detection is important to optimally tailor treatment. We aimed to determine the prevalence and distribution of inflammatory lesions in peripheral joints and entheses in newly diagnosed IBD patients. DESIGN Patients with newly diagnosed IBD from a prospective population-based inception cohort were consecutively included. Data on MSK symptoms were collected by questionnaires and by structured rheumatological interview. Peripheral joints and entheses were assessed clinically and by ultrasound [US], using standardized definitions. RESULTS Of 110 included patients (mean age: 42 years, 40% male, 70 with ulcerative colitis [UC], 40 with Crohn's disease [CD]), a history of ≥1 peripheral musculoskeletal symptom was reported by 49%. Clinical examination revealed peripheral MSK manifestations in 56 [52.3%] patients; 29 [27.1%] had ≥1 tender and/or swollen joints and 49 [45.8%] ≥1 tender entheses. Small peripheral joints were predominantly affected. US found inflammation in ≥1 joint or enthesis in 52 [49.5 %] patients; 29 [27.4 %] had US synovitis in ≥1 joint, while 36 [34%] had US enthesitis. Fibromyalgia classification criteria were fulfilled in seven [7.9%] patients. There was no difference in clinical or US findings between patients with UC and CD, nor between patients with active and inactive IBD. CONCLUSION Half of the patients with newly diagnosed IBD had inflammation in their peripheral joints and/or entheses, documented by rheumatological clinical and US evaluations. This indicates a need for multidisciplinary collaboration to ensure an optimal therapeutic strategy for suppressing inflammation in all disease domains.
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Affiliation(s)
- Nora Vladimirova
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mohamed Attauabi
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Gorm Madsen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Viktoria Fana
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Charlotte Wiell
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Uffe Møller Døhn
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Flemming Bendtsen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Seidelin
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Johan Burisch
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Akrapovic Olic I, Vukovic J, Radic M, Sundov Z. Enthesitis in IBD Patients. J Clin Med 2024; 13:4540. [PMID: 39124806 PMCID: PMC11313216 DOI: 10.3390/jcm13154540] [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: 06/05/2024] [Revised: 07/04/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Inflammatory bowel disease (IBD) is marked by chronic inflammation of the gastrointestinal tract and encompasses two major subtypes, Crohn's disease (CD) and ulcerative colitis (UC). IBD is frequently accompanied by extraintestinal manifestations (EIMs), with axial and peripheral spondyloarthritis (SpA) being the most common. Enthesitis, an inflammation of the bone insertions of capsules, ligaments, and tendons, represents an initial lesion in SpA. However, enthesitis remains an underestimated and often obscured EIM. The early detection of subclinical entheseal involvement in IBD patients using ultrasound (US) could provide an opportunity for timely intervention. US is a more feasible and affordable approach than magnetic resonance imaging (MRI). While previous meta-analyses have reported on the incidence and prevalence of SpA in IBD, specific attention to enthesitis has been lacking. Therefore, this narrative review aims to assess the current knowledge on existing IBD-SpA cohorts, focusing specifically on enthesitis.
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Affiliation(s)
- Ivna Akrapovic Olic
- Internal Medicine Department, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia; (J.V.); (M.R.); (Z.S.)
- Gastroenterology and Hepatology Department, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
| | - Jonatan Vukovic
- Internal Medicine Department, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia; (J.V.); (M.R.); (Z.S.)
- Gastroenterology and Hepatology Department, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
| | - Mislav Radic
- Internal Medicine Department, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia; (J.V.); (M.R.); (Z.S.)
- Internal Medicine Department, Rheumatology, Allergology and Clinical Immunology Division, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
| | - Zeljko Sundov
- Internal Medicine Department, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia; (J.V.); (M.R.); (Z.S.)
- Gastroenterology and Hepatology Department, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
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Huber MK, Valim V, Serrano ÉV, Mendonça JA, Lourenço RB, Espírito Santo TMR, Nordal H, de Fátima Bissoli M, de Oliveira Gavi MBR. Prevalence of spondyloarthritis in inflammatory bowel disease according ASAS and ultrassonography and its correlation with plasma calprotectin. Adv Rheumatol 2024; 64:27. [PMID: 38622711 DOI: 10.1186/s42358-023-00348-6] [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: 09/28/2023] [Accepted: 12/24/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Enteropathic spondyloarthritis is underdiagnosed and inflammatory biomarkers and ultrasonography (US) could be useful for screening inflammatory bowel disease (IBD) patients. The objective of this study was to evaluate the prevalence of spondyloarthritis (SpA) in IBD patients, according to the Assessment of SpondyloArthritis International Society (ASAS) criteria and the correlation of results of US of entheses and joints with plasma calprotectin levels. METHODS This was an observational cross-sectional study. Patients from the IBD outpatient clinic of a reference center were evaluated according to ASAS criteria classification, results of US of entheses and joints, and inflammatory biomarker measurements (erythrocyte sedimentation rates, C-reactive protein levels, fecal and plasma calprotectin levels). A p value lower than 0.05 was considered significant. RESULTS A total of 30.5% of the studied sample (n = 118) of patients with IBD presented at least one inflammatory musculoskeletal manifestation. The overall prevalence of enteropathic SpA was 13.55%, with 10.16% axial SpA and 4.23% peripheral SpA according to the ASAS criteria. A total of 42.1% of patients had an MASEI score greater than 18, 35.2% had synovitis, and 14.7% had tenosynovitis on US, increasing the frequency of diagnosis of enteropathic SpA to 22.8%. Plasma calprotectin levels were similar to those in healthy controls, and correlated only with the fecal calprotectin level (p 0.041). CONCLUSIONS A total of 13.5% of patients met the criteria in accordance with the ASAS criteria for enteropathic SpA, which increased to 22.8% with the addition of US. The prevalence of enthesitis, synovitis and tenosynovitis by US of symptomatic joints and entheses were 42%, 35% and 14.7% respectively. Plasma calprotectin was correlated with fecal calprotectin but not with inflammatory biomarkers or US or ASAS criteria.
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Affiliation(s)
- Míriam Küster Huber
- Program in Public Health of Health Science Center of Federal University of Espírito Santo (PPGSC-UFES), Vitoria, Espírito Santo, Brazil
| | - Valeria Valim
- Program in Public Health of Health Science Center of Federal University of Espírito Santo (PPGSC-UFES), Vitoria, Espírito Santo, Brazil.
- Medicine Department of Federal University of Espírito Santo (UFES), University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil.
| | - Érica Vieira Serrano
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
| | | | - Rafael Burgomeister Lourenço
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
| | | | - Hilde Nordal
- Haukeland Hospital, University of Bergen, Bergen, Norway
| | - Maria de Fátima Bissoli
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
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Sabido-Sauri R, Baraliakos X, Aydin SZ. Enthesopathies - Mechanical, inflammatory or both? Best Pract Res Clin Rheumatol 2024; 38:101966. [PMID: 39019747 DOI: 10.1016/j.berh.2024.101966] [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: 06/10/2024] [Accepted: 06/22/2024] [Indexed: 07/19/2024]
Abstract
Entheses have the challenging task of transferring biomechanical forces between tendon and bone, two tissues that differ greatly in composition and mechanical properties. Consequently, entheses are adapted to withstand these forces through continuous repair mechanisms. Locally specialized cells (mechanosensitive tenocytes) are crucial in the repair, physiologically triggering biochemical processes to maintain hemostasis. When repetitive forces cause "material fatigue," or trauma exceeds the entheses' repair capacity, structural changes occur, and patients become symptomatic. Clinical assessment of enthesopathies mainly depends on subjective reports by the patient and lacks specificity, especially in patients with central sensitization syndromes. Ultrasonography has been increasingly used to improve the diagnosis of enthesopathies. In this article, the literature on how biomechanical forces lead to entheseal inflammation, including factors contributing to differentiation into a "clinical enthesitis" state and the value of ultrasound to diagnose enthesopathies will be reviewed, as well as providing clues to overcome the pitfalls of imaging.
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Affiliation(s)
| | | | - Sibel Zehra Aydin
- Division of Rheumatology, Department of Medicine, University of Ottawa, Canada; Ottawa Hospital Research Institute, Canada.
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Sakellariou G, Schiepatti A, Scalvini D, Lusetti F, Fazzino E, Biagi F, Montecucco C. Musculoskeletal Ultrasound to Identify Subclinical Joint and Periarticular Involvement in Patients With Inflammatory Bowel Disease: A Systematic Literature Review. Front Med (Lausanne) 2022; 9:919521. [PMID: 35652081 PMCID: PMC9149094 DOI: 10.3389/fmed.2022.919521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Musculoskeletal ultrasonography identifies subclinical joint and entheseal inflammation, and it might be of value in patients with inflammatory bowel diseases (IBD), which are at higher risk of inflammatory arthropathy and disability. Our aim was to retrieve the evidence on the applications of ultrasound in patients with non-arthropathic IBD. METHODS Studies enrolling patients with IBD without arthritis, undergoing ultrasound of joints, tendons or entheses were eligible. The outcomes of interest encompassed the frequency of ultrasound-detected lesions, their accuracy in diagnosing arthritis, their prognostic role and sensitivity to change. All study types, excluding case reports, case series and narrative reviews, were included. Search strategies were applied in PubMed and Embase. Abstract and full-texts were evaluated by pairs of reviewers. The risk of bias was evaluated through the Newcastle-Ottawa scale or the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2. The protocol was registered in PROSPERO (CRD42021264972). RESULTS Out of 2,304 records, eight studies were included, all reporting the frequency of lesions, while only three evaluated also the diagnostic accuracy. All studies had a cross-sectional design, with no evidence on prediction or follow-up. All studies evaluated the entheses, while only three the joints. The most common chronic lesions were entheseal thickening (up to 81.5%) and enthesophytes (67.9%), while entheseal erosions were present in 16%-17% of patients. Among inflammatory lesions, power Doppler was reported in 14%-67% of patients. There were no differences among Crohn's disease or ulcerative colitis and depending on disease activity, while there were contrasting results on different disease durations. When evaluating the diagnostic performance, the best specificity for a diagnosis if IBD was 0.88 (95%CI, 0.8-0.94) for joint abnormalities. Also, the best sensitivity was 0.88 (95%CI, 0.76-0.95) for entheseal lesions. No studies assessed of the combination of lesions. Due to the limited number of studies, meta-analyses were not performed. CONCLUSIONS Despite the possible value of ultrasound in IBD, there is limited evidence deriving from cross-sectional studies. Longitudinal studies are needed to clarify the role of this technique, while its current placement might be that of complementing clinical assessment, in particular in early intestinal disease.
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Affiliation(s)
- Garifallia Sakellariou
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Annalisa Schiepatti
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
- Gastroenterology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Davide Scalvini
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
- Gastroenterology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Francesca Lusetti
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
- Gastroenterology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Erica Fazzino
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
- Gastroenterology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Federico Biagi
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
- Gastroenterology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
- Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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8
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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: 2] [Impact Index Per Article: 0.5] [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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Husic R, Lackner A, Kump PK, Högenauer C, Graninger W, Dejaco C. High Prevalence of Ultrasound Verified Enthesitis in Patients With Inflammatory Bowel Disease With or Without Spondylarthritis. Front Med (Lausanne) 2021; 8:637459. [PMID: 33644102 PMCID: PMC7906964 DOI: 10.3389/fmed.2021.637459] [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] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Inflammatory bowel disease (IBD) is closely associated with spondylarthritis (SpA) and enthesitis, as an important feature of SpA, is a common extraintestinal manifestation of IBD. Enthesitis may be clinically silent in a high proportion of patients with IBD without clinical signs or a diagnosis of SpA. Objectives: The aim of this study was to compare the prevalence of ultrasound (US) verified enthesitis in IBD patients with and without SpA, with patients with irritable bowel syndrome (IBS) and healthy subjects (HC) serving as controls. Methods: IBD patients with or without SpA, patients with IBS and HC were prospectively recruited and clinically assessed. Ultrasound examination was performed at 14 entheses. The ultrasound abnormalities were scored according to the Madrid Ankylosing Spondylitis Enthesitis Index (MASEI). Results: We included 33 IBD patients without SpA, 14 IBD patients with SpA, 26 IBS patients and 18 HC. Higher MASEI scores were found in patients with IBD without SpA [median 21.0 range (8.0–53.0)] and IBD associated SpA [33.0 (8–50)] than in IBS patients [10.5 (0–42.0)-p < 0.001 for both comparison] and HC [12.0 (2.0–38.0)-p < 0.01]. PD, enthesophytes and erosions were more common in patients with IBD with or without SpA as compared to IBS patients and HC. IBD patients with SpA compared to IBD without SpA demonstrated significant higher prevalence of erosion and structural irregularity and consequently significant higher MASEI (p < 0.05 for all comparison). Conclusions: Ultrasound verified enthesitis is more common in patients with IBD with or without SpA as compared to patients with IBS or HC.
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Affiliation(s)
- Rusmir Husic
- Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Angelika Lackner
- Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | | | - Christoph Högenauer
- Department of Gastroenterology and Hepatology, Medical University Graz, Graz, Austria
| | - Winfried Graninger
- Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria.,Department of Rheumatology, Hospital of Brunico (Südtiroler Sanitätsbetrieb-Azienda Sanitaria dell'Alto Adige), Brunico, Italy
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Bertolini E, Macchioni P, Rizzello F, Salice M, Vukatana G, Sandri G, Bertani A, Ciancio G, Govoni M, Zelante A, Malavolta N, Beltrami M, Salvarani C. Ultrasonographic and clinical assessment of peripheral enthesitis and arthritis in an Italian cohort of inflammatory bowel disease patients. Semin Arthritis Rheum 2020; 50:436-443. [PMID: 32061429 DOI: 10.1016/j.semarthrit.2020.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/08/2019] [Accepted: 01/07/2020] [Indexed: 01/22/2023]
Abstract
AIMS To evaluate the prevalence of clinical and ultrasonographic musculoskeletal involvement in Italian patients with inflammatory bowel disease (IBD). METHODS In this cross-sectional multicenter study, 148 consecutive patients with IBD were evaluated by a gastroenterologist and a rheumatologist. All patients underwent a B-mode and power Doppler ultrasonographic examination of 6 pairs of entheses and of knee and ankle joints. RESULTS A positive history for at least one musculoskeletal manifestation was reported by 40.5% of patients, more frequently in ulcerative colitis (UC) (p = 0.033). Inflammatory back pain was reported by 13.5% of patients, and a past history of peripheral arthritis by 14.9%, entheseal inflammation by 14.2% and dactylitis by 2.7%. At clinical examination, arthritis was observed in 19.6% of patients and enthesitis in 33%. Oligoarthritis and enthesitis at clinical examination were more frequently observed in UC than in Crohn disease (CD). 37.8% of total IBD patients fulfilled ASAS classification criteria for axial and/or peripheral spondyloarthritis, 8.1% ASAS classification criteria for axial spondyloarthritis, and 29.7% ASAS classification criteria for peripheral spondyloarthritis. With ultrasonographic examination, signs of entheseal involvement were observed in 87.8% of patients, while at power Doppler, ≥1 abnormality was observed in 27.1%. ASAS+ patients compared to those ASAS- had a significantly higher frequency at ultrasonography of acute entheseal abnormalities, power Doppler entheseal positivity and joint involvement. These abnormalities at ultrasonography were also observed in 34%, 13% and 12% of ASAS- patients. CONCLUSIONS Musculoskeletal manifestations occur frequently in patients with IBD. Ultrasonographic entheseal and joint involvement were also observed in asymptomatic patients.
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Affiliation(s)
- Elena Bertolini
- Medicina Gastroenterologica e, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Fernando Rizzello
- Dipartimento di Medicina Interna e Gastroenterologia e, Università di Bologna-Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Marco Salice
- Dipartimento di Medicina Interna e Gastroenterologia e, Università di Bologna-Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Gentiana Vukatana
- Reumatologia, Università di Bologna-Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Gilda Sandri
- Reumatologia e, Azienda Ospedaliero-Unversitaria di Modena e Università di Modena e Reggio Emilia, Modena, Italy
| | - Angela Bertani
- Gastroenterologia, Azienda Ospedaliero-Unversitaria di Modena e Università di Modena e Reggio Emilia, Modena, Italy
| | - Giovanni Ciancio
- Reumatologia, Azienda Ospedaliero-Universitaria S. Anna di Ferrara (Cona) e Università di Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Reumatologia, Azienda Ospedaliero-Universitaria S. Anna di Ferrara (Cona) e Università di Ferrara, Ferrara, Italy
| | - Angelo Zelante
- Gastroenterologia, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - Nazzarena Malavolta
- Reumatologia, Università di Bologna-Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Marina Beltrami
- Medicina Gastroenterologica e, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Reumatologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Reumatologia e, Azienda Ospedaliero-Unversitaria di Modena e Università di Modena e Reggio Emilia, Modena, Italy.
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11
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Di Matteo A, Filippucci E, Cipolletta E, Satulu I, Hurnakova J, Lato V, De Angelis R, Horvath R, Pavelka K, Salaffi F, Grassi W. Entheseal involvement in patients with systemic lupus erythematosus: an ultrasound study. Rheumatology (Oxford) 2018; 57:1822-1829. [PMID: 29982722 DOI: 10.1093/rheumatology/key189] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives The main objective of this study is to explore the prevalence and distribution of entheseal US changes in a cohort of SLE patients, taking as controls a group including both PsA patients and healthy subjects. The secondary objective is to investigate the correlation between the US findings and the clinical and serological data in SLE patients. Methods Clinical and US assessment of quadriceps, patellar and Achilles tendons, and plantar fascia entheses were performed by independent rheumatologists on 65 patients with SLE, 50 patients with PsA and 50 healthy subjects. US findings were identified according to the OMERACT definitions. In SLE patients, the correlation between the US changes and the clinical and laboratory findings was evaluated. Results US revealed one or more abnormalities in at least one enthesis in 44 out of 65 SLE patients (67.7%), 47 out of 50 PsA patients (94.0%) and 22 out of 50 healthy subjects (44.0%). In SLE patients, US findings indicating active inflammation were significantly more frequently detected than in healthy subjects (P < 0.001). The distal enthesis of the patellar tendon was the most commonly involved. The presence of power Doppler signal at the enthesis was an independent predictor of SLE disease activity (SLEDAI-2k P < 0.001, β = 0.52; musculoskeletal-BILAG P < 0.001, β = 0.56). Conclusion The burden of entheseal sonographic changes was significantly higher in SLE patients than in healthy subjects, especially as regards active inflammation. The presence of power Doppler signal at the enthesis may represent a potential biomarker of SLE disease activity.
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Affiliation(s)
- Andrea Di Matteo
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Carlo Urbani Hospital, Polytechnic University of Marche, Jesi, Ancona, Italy
| | - Emilio Filippucci
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Carlo Urbani Hospital, Polytechnic University of Marche, Jesi, Ancona, Italy
| | - Edoardo Cipolletta
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Carlo Urbani Hospital, Polytechnic University of Marche, Jesi, Ancona, Italy
| | - Iulia Satulu
- Rheumatology Department, Internal Medicine Clinic, Kalmar County Hospital, Kalmar, Sweden
| | - Jana Hurnakova
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Pediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic
| | - Valentina Lato
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Carlo Urbani Hospital, Polytechnic University of Marche, Jesi, Ancona, Italy
| | - Rossella De Angelis
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Carlo Urbani Hospital, Polytechnic University of Marche, Jesi, Ancona, Italy
| | - Rudolf Horvath
- Department of Pediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Fausto Salaffi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Carlo Urbani Hospital, Polytechnic University of Marche, Jesi, Ancona, Italy
| | - Walter Grassi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Carlo Urbani Hospital, Polytechnic University of Marche, Jesi, Ancona, Italy
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Bakirci Ureyen S, Karacaer C, Toka B, Erturk Z, Eminler AT, Kaya M, Tascilar K, Tamer A, Uslan I, Kurum E, McGonagle D, Aydin SZ. Similar subclinical enthesitis in celiac and inflammatory bowel diseases by ultrasound suggests a gut enthesis axis independent of spondyloarthropathy spectrum. Rheumatology (Oxford) 2018; 57:1417-1422. [PMID: 29741671 DOI: 10.1093/rheumatology/key102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Higher subclinical enthesitis on US has been reported in IBD and celiac disease, separately. The objective of this study was to compare IBD and celiac disease for enthesitis on US. Higher enthesitis scores in IBD compared with celiac disease would support a shared pathogenic mechanism between IBD and spondyloarthritis, whereas similar scores may suggest a general impact of gut inflammation on the enthesis. Methods Patients with IBD, celiac disease and healthy controls (HCs) were recruited and 12 entheses were scanned by US, blind to the diagnosis and clinical assessment. Elementary lesions for enthesitis were scored on a scale between 0 and 3, for inflammation, damage and total US scores. Results A total of 1260 entheses were scanned in 44 patients with celiac disease, 43 patients with IBD and 18 HCs. The three groups were matched for age and BMI. Patients with celiac disease and IBD had higher inflammation scores than HCs [10.4 (6.5), 9.6 (5.4) and 5.6 (5.2), respectively, P = 0.007) whereas damage scores were similar. Both age and BMI had significant effects on the entheseal scores, mostly for inflammation scores but when controlling for these the US enthesopathy scores were still higher in celiac disease and IBD. Conclusion The magnitude of subclinical enthesopathy scores is similar between celiac disease and IBD in comparison with HCs. These findings suggest that the common factor between both diseases and enthesopathy is abnormal gut permeability, which may be modified by the genetic architecture of IBD leading to clinical arthropathy.
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Affiliation(s)
- Sibel Bakirci Ureyen
- Department of Internal Medicine, Division of Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Cengiz Karacaer
- Department of Internal Medicine, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Bilal Toka
- Department of Internal Medicine, Division of Gastroenterology, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Zeynep Erturk
- Department of Internal Medicine, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Ahmet Tarik Eminler
- Department of Internal Medicine, Division of Gastroenterology, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Muhammed Kaya
- Department of Internal Medicine, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Koray Tascilar
- Department of Internal Medicine, Division of Rheumatology, Istanbul Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Ali Tamer
- Department of Internal Medicine, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Ihsan Uslan
- Department of Internal Medicine, Division of Gastroenterology, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Esra Kurum
- Department of Statistics, University of California, Riverside, Riverside, CA, USA
| | - Dennis McGonagle
- Depertment of Internal Medicine, Division of Rheumatology, Leeds Institute of the Rheumatic and Musculoskeletal Disease, Leeds, UK.,University of Leeds, Faculty of Medicine, Rheumatology, Leeds, UK
| | - Sibel Zehra Aydin
- Department of Internal Medicine, Division of Rheumatology, University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada
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Elalouf O, Bakirci Ureyen S, Touma Z, Anderson M, Kaeley GS, Aydin SZ, Eder L. Psoriatic Arthritis Sonographic Enthesitis Instruments: A Systematic Review of the Literature. J Rheumatol 2018; 46:43-56. [DOI: 10.3899/jrheum.171466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/22/2022]
Abstract
Objective.As part of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) ultrasound working group, we performed a systematic review of the literature to assess the evidence and knowledge gaps in scoring instruments of enthesitis in psoriatic arthritis (PsA).Methods.A systematic search of PubMed, EMBase, and Cochrane databases was performed. The search strategy was constructed to find original publications containing terms related to ultrasound, enthesitis, spondyloarthritis (SpA) or PsA. Data extraction focused on the properties of the sonographic enthesitis instruments used in each study following components of the Outcome Measures in Rheumatology (OMERACT) filter: feasibility, test-retest reliability, construct validity as related to clinical assessment of enthesitis, biomarkers of inflammation and imaging of enthesitis by other modalities, discriminative validity, and responsiveness to treatment.Results.Fifty-one of 310 identified manuscripts were included. Only 1 scoring instrument of enthesitis was specifically developed and validated in patients with PsA. Only 18 (35%) of the studies involved patients with PsA, while the remaining studies focused on SpA. In PsA, construct validity was assessed using biomarkers and clinical examination in 1 (2%) and 11 (21.5%) of the studies, respectively, whereas no studies used imaging for the same purpose. Only 2 (4%) of the studies assessed discriminative validity in PsA. Responsiveness to treatment was assessed in 7 studies, none of which included patients with PsA.Conclusion.Although sonographic enthesitis scoring instruments have been developed for SpA, only a few have been validated in PsA. None of them passed the OMERACT filter in patients with PsA. Additional research is required before endorsing a specific instrument for the assessment of enthesitis in patients with PsA.
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Performance of Two Screening Questionnaires for Inflammatory Arthritis in Patients with Inflammatory Bowel Disease. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8618703. [PMID: 29854801 PMCID: PMC5964541 DOI: 10.1155/2018/8618703] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/22/2018] [Accepted: 04/01/2018] [Indexed: 01/21/2023]
Abstract
Musculoskeletal symptoms are the most common extraintestinal manifestations of inflammatory bowel disease (IBD). An essential step in the management of these patients is to establish referral algorithms through the use of appropriate screening tools. Our objective was to evaluate the performance of two simple questionnaires to detect inflammatory arthritis (IA) in patients with IBD. Two questionnaires, one for detecting axial IA and the other for peripheral IA, were tested among 112 IBD unselected consecutive patients of both sexes, aged 18–45 years. The study period was from January to December 2016. Each questionnaire was composed of three simple questions. If the patient answered affirmatively at least to two of the three questions, the questionnaire was considered positive. Clinical diagnosis of IA based on an expert's opinion was the reference gold standard. To obtain a weighted value of sensitivity and specificity, likelihood ratio (LR) values were calculated. Twenty-seven percent of the patients were considered positive responders to the axial questionnaire while 32% were considered positive responders to the peripheral questionnaire. Twenty-four patients (21.4%) were diagnosed with axial IA, whereas 26% had peripheral IA. The axial questionnaire yielded a sensitivity of 87.5% (67.6–97.3), specificity of 89.8% (81.5–92.2) and LR+ of 8.6 (4.5–16.2). For the peripheral questionnaire, these values were 82.8% (64.2–94.2), 87.4% (79–93.3), and 6.6 (3.8–11.4), respectively. Both questionnaires showed an adequate screening capacity for IA in patients with IBD. Their specificity, together with their simplicity, can make them suitable detection tools in gastroenterology and general medicine consultations.
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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: 1.9] [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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Rovisco J, Duarte C, Batticciotto A, Sarzi-Puttini P, Draghessi A, Portela F, Gutierrez M. Erratum to: Hidden musculoskeletal involvement in inflammatory bowel disease: a multicenter ultrasound study. BMC Musculoskelet Disord 2016; 17:241. [PMID: 27250721 PMCID: PMC4890472 DOI: 10.1186/s12891-016-1098-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2025] Open
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