Frequency of irritable bowel syndrome in spondyloarthritis: a multicentric cross-sectional study and meta-analysis

OBJECTIVE

To evaluate the prevalence of symptoms and factors associated with irritable bowel syndrome (IBS) in axial spondyloarthritis (ax-SpA).

METHODS

In a cross-sectional multicentric study, consecutive patients with ax-SpA treated with biologics in five rheumatology departments were asked for IBS Rome IV criteria. Demographic data, lifestyle behaviours and disease characteristics were recorded. Second, a systematic literature review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Of the 500 patients with ax-SpA included, 124 reported IBS symptoms (25%). Female gender, unemployment, higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and worse Bath Ankylosing Spondylitis Functional Index scores, multiple lines of biologics, fibromyalgia, anxiety, depression and lower physical activity were associated with IBS symptoms. In multivariate model, the risk of IBS was associated with anxiety and physical inactivity. From the literature review, the prevalence of IBS in patients with SpA was 15.4% (8.8% to 23.3%). Meta-analysis of the five studies comparing the presence of IBS in patients with SpA (323/7292) and healthy controls (484/35587) showed a significant increase of IBS in patients with SpA (OR=1.59 (1.05 to 2.40)).

CONCLUSION

The prevalence of IBS symptoms was high in the ax-SpA population and should therefore be considered in the presence of gastrointestinal disorders. The presence of IBS symptoms was associated with anxiety and low physical activity in multivariate analysis. Patients with IBS symptoms tended to have more difficult to manage disease characterised by higher activity, worse functional score and multiple lines of treatment in univariate analysis.

Conservative management of equine tarsal collateral ligament injuries may allow return to normal performance

OBJECTIVE

To describe type and distribution of tarsal collateral ligament (CL) injuries and to assess the long-term outcome in horses treated conservatively.

ANIMALS

78 horses (median age, 7 years [IQR, 4 to 9.75 years]) of different breeds and disciplines.

PROCEDURES

Retrospective analysis (2000 through 2020) of horses with tarsal CL lesions diagnosed on ultrasound. The resting time, ability to return to work, and performance level after the injury were compared between horses having a single ligament (group S) or multiple ligaments (group M) affected and according to the case severity.

RESULTS

Most of the horses (57/78) presented a single CL injury, while 21 had multiple CLs affected simultaneously, for a total of 108 CLs injured and 111 lesions. In both groups, the short lateral CL (SLCL) was the most commonly affected (44/108), followed by the long medial CL (LMCL; 27/108). Enthesopathies (72.1%) were more frequent than desmopathies alone (27.9%) and involved mostly the proximal insertion of the SLCL and the distal attachment of the LMCL. Conservative treatment (n = 62) consisted mainly of stall rest. The median resting time (120 days [IQR, 60 to 180 days]) did not significantly differ between the 2 groups (group S vs M) or according to the severity. Most horses (50/62) were able to return to work within 6 months. Horses that did not return (12/62) were more likely to have severe lesions (P = .01). Thirty-eight horses were able to perform at a level equal to or higher than before the injury.

CLINICAL RELEVANCE

This study highlights the importance of thorough ultrasound assessment of tarsal CL injuries and demonstrates that conservative management is a viable option to allow these horses to return to previous performance level.

CT diagnosis of pituitary abscess, suppurative meningitis, and atlanto-occipital septic arthritis in a pony

A 15-year-old pony was presented for acute neurological signs. Neurological examination suggested a brainstem lesion, blood laboratory tests detected an active inflammatory process, and upper respiratory endoscopy identified a suppurative lesion at the dorsal aspect of the right guttural pouch. Computed tomography was performed and findings were consistent with pituitary abscess, meningitis, and atlanto-occipital joint septic arthritis. Imaging findings were confirmed based on cerebrospinal and synovial fluid cultures and necropsy. Computed tomography provided important information for identifying the cause of the patient's neurological signs and helped the owner make a final decision for euthanasia.

Identification of an ectopic periorbital lymph node in two horses

Background

To describe the clinical presentation and treatment of an ectopic periorbital lymph node in two young horses.

Case Description

Two warm-blood horses were presented at the equine clinic of the University of Liège with a periorbital non-painful mass. Differential diagnosis included neoplasm (lymphoma), (sterile) abscess, cyst, ectopic lacrimal gland tissue, hematoma, adipose tissue, or ectopic lymphoid tissue. Information collected included physical and ophthalmic examination findings, results of the ocular and periocular ultrasound, surgical procedure, histopathology, and follow-up. Masses of 2 × 2 cm and 3 × 2 cm subcutaneous, ovoid, smooth, and firm mass were observed in the zygomatic region of the head. On ultrasound, the mass appeared as a hypoechoic subcutaneous structure. Cytology showed a mixed lymphocytic cell population. No abnormal mitotic activity was observed. Histopathology revealed a chronic markedly reactive lymph node.

Conclusion

To the authors' knowledge, this is the first description of periorbital ectopic lymph nodes in veterinary medicine. Ectopic lymph nodes should therefore be included in the differential diagnosis of periocular masses in animals. Surgery was easily performed and was curative.

Comparison Between Ultrasonographic and Standing Magnetic Resonance Imaging Findings in the Podotrochlear Apparatus of Horses With Foot Pain

This prospective study aimed to blindly compare the ultrasonographic and standing magnetic resonance imaging (sMRI) findings in deep digital flexor tendon (DDFT), navicular bone, and navicular bursa in horses with foot pain, positive digital analgesia, and without definitive radiographic diagnosis. Ultrasonography detected more DDFT abnormalities (32/34 feet vs. 27/34 with sMRI) but identified less palmar navicular abnormalities (23/34 feet vs. 30/34 with sMRI). In suprasesamoidean DDFT lesions, which were mainly dorsally located, changes in echogenicity did not correspond to a particular pattern of sMRI signal change. Transcuneal ultrasonography did not allow assessment of morphology and extent of distal DDFT lesions, and sporadically discriminated the affected lobe compared to sMRI. Defects of the palmar compact bone were identified with both modalities except a parasagittal defect, which was only seen at sMRI.

Retinal detachment secondary to vitreoretinopathy in two closely related warmblood horses

Background:

To describe the clinical, diagnostic imaging, and histopathological findings of two visually impaired closely related horses and to identify a possible cause.

Case Description:

Two warmblood horses, with a common dam and sire, were presented to the ophthalmology department of Liège for investigation of impaired vision. Information collected included physical and ophthalmic examination findings, results of ocular ultrasound, electroretinogram, magnetic resonance imaging (MRI), and histopathology. Ophthalmic examination, ocular ultrasound and MRI revealed a complete retinal detachment (RD) in the left eye and vitreous synaeresis in both eyes of both horses. Electroretinograms showed a normal response in both right eyes but a total loss of the retinal response in their left eyes. Histopathologic examination revealed multifocal retinal dysplasia in both left eyes.

Conclusion:

In these two horses, RD has likely been caused by the congenital posterior segment abnormalities of the vitreous and the retina. A vitreoretinopathy is highly suspected and is possibly hereditary in these closely related siblings.