Background:Musculoskeletal symptoms represent the most common extraintestinal manifestations of inflammatory bowel disease (IBD) and a major cause of impaired quality of life in these patients. Spondyloarthritis (SpA) is classically associated with IBD, but other rheumatic manifestations may occur.Objectives:To characterize musculoskeletal symptoms and rheumatic diseases in an IBD cohort.Methods:Retrospective monocentric descriptive study including all the patients with IBD consecutively reffered from Gastroenterology to the Rheumatology Department between January of 2013 and December 2020 in a tertiary university hospital. Demographic and clinical data and musculoskeletal symptoms were collected at the time of the first visit in the Rheumatology outpatient center and the rheumatic diseases diagnosed during the entire follow-up were registered.Results:A total of 234 patients were included, 136 (58.1%) females, 20 (8.5%) smokers. At the first Rheumatology consultation the mean age was 43.6 (±13.7) years and the mean IBD duration was 11.7 (±9.7) years. Concerning IBD: 172 (73.5%) had Crohn’s disease and 62 (26.5%) had ulcerative colitis; azathioprine (39.7%), infliximab (28.2%) and mesalazine (26.5%) were the most frequently used drugs; eleven patients (4.7%) were taking glucocorticoids and 106 (45.3%) had already been treated with glucocorticoids.Regarding musculoskeletal symptoms: 76 (32.5%) patients had peripheral symptoms and 98 (41.9%) had axial symptoms (Table 1).Table 1.Characterization of peripheral and axial musculoskeletal symptoms in patients with Inflammatory Bowel Disease.N (%)Peripheral symptomsNo158 (67.5%)Arthritis / “inflammatory” joint pain24 (10.3%)“Mixed” rhythm joint pain15 (6.4%)“Mechanical” joint pain29 (12.4%)Enthesopathy8 (3.4%)Axial symptomsNo136 (58.1%)“Inflammatory” back pain46 (19.7%)“Mixed” rhythm back pain35 (14.9%)“Mechanical” back pain17 (7.3%)Total234 (100%)Twenty-six (11.1%) patients had radiographic sacroiliitis, 14 (6.0%) had sacroiliitis in computed tomography and 9 (3.8%) in magnetic resonance. Forty-four (18.8%) patients fulfilled Assessment of SpondyloArthritis international Society (ASAS) criteria for axial SpA and 5 (2.1%) for peripheral SpA. Also of note, 16 (6.8%) patients had a previous diagnosis of psoriasis and 5 (2.1%) had uveitis in the past.Concerning other rheumatic diagnosis, we observed: osteoarthritis in 64 (27.3%), osteoporosis in 16 (6.9%), diffuse idiopathic skeletal hyperostosis in 6 (2.6%), systemic lupus erythematosus in 4 (1.7%), rotator cuff tendinopathy in 2 (0.9%), rheumatoid arthritis, gout, calcium pyrophosphate deposition disease, fibromyalgia, drug-induced lupus, osteitis condensans ilii, Dupuytren’s contracture and avascular necrosis of the femoral head in 1 (0.4%), each.Conclusion:Our results demonstrate a high prevalence of musculoskeletal symptoms and rheumatic diseases in patients with IBD. These diagnoses are not limited to the group of SpA and osteoporosis, emphasizing the importance of rheumatologists being alert to other rheumatic diagnoses in patients with IBD.Disclosure of Interests:None declared
Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era
