Diagnostic Algorithm for Joint Pain in Patients with Inflammatory Bowel Disorders

Aim. An algorithm development for joint pain differential diagnosis in patients with inflammatory bowel disorders (IBD) and its validation in clinical practice.Materials and methods. A total of 349 IBD patients hospitalised for gastroenterological complaints at the Chelyabinsk Regional Clinical Hospital during 2017–2020 have been examined.Results. Upon survey, 97 (27.8%) IBD patients complained of joint pain. Ulcerative colitis (UC) predominated (79 patients; 81.4%), Crohn’s disease (CD) had a 18.6% incidence. In survey, 27% UC and 32.1% CD patients reported joint pain (p = 0.26). Among IBD patients, 52.6% had mechanical, and 47.4% — inflammatory pain. The inflammatory back pain (IBP) rate in survey cohort was 23.7%. Use of a diagnostic algorithm allowed concomitant rheumatic disease detection in 7 (7.2%) patients from the IBD–joint pain cohort: 2 patients were diagnosed with psoriatic spondyloarthritis, 2 — rheumatoid arthritis, 1 — gout and 2 — with ankylosing spondylitis. IBD-associated arthritis was diagnosed in 41 (42.3%) cases, osteoarthritis — in 38 (39.2%) IBD patients with joint pain, arthralgia with no objective inflammation, impaired joint function or lesions in X-ray and/or ultrasound — in 13 (13.4%) patients.Conclusion. Joint pain complaints are common in IBD patients and require a multispecialty rheumatologists-involving approach to proceed with differential diagnosis and opting for treatment tactics. A clinically verified algorithm coupled with laboratory tests and instrumental imaging facilitates diagnosis and optimal therapy selection in IBD patients with complaints of joint pain.

TNFSF13B, the gene that encodes the B-cell activating factor and B-lymphocyte stimulator (BAFF/BLyS), is expressed differently in the blood of Crohn's disease patients

Crohn's disease and ulcerative colitis are examples of inflammatory bowel disorders (IBD) (1). We usedpublicly available microarray data to figure out how gene expression in the hematopoietic compartment ofCrohn's disease patients differs from healthy controls (2-4). We discovered that BAFF, also known as the Blymphocytestimulator (BLyS), encoded by the gene TNFSF13B (5), was differently expressed in the blood ofCrohn's Disease patients in two datasets (2, 3). BAFF was shown to be among the genes most differentlyexpressed in monocyte-derived macrophages from Crohn's Disease patients in a third dataset (4). Inindividuals with IBD, serum BAFF, fecal BAFF, and BAFF expression in the intestinal mucosa have all beenshown to be higher (6, 7). The expression of BAFF in the peripheral blood of Crohn's disease patients issimilarly enhanced, as seen below.

Colorectal and lower gastrointestinal surgery

The lower gastrointestinal tract includes most of the small intestine and all of the large intestine. The patient presenting with an acute abdomen may have a bowel obstruction which could lead to ischaemia and perforation. Thorough assessment and close observation are imperative, because, if surgical intervention is indicated, this needs to be performed promptly. This chapter provides an overview of inflammatory bowel disorders, tumours, hernias, obstructions, the acute abdomen, ischaemic bowel, complications of bowel surgery, and stomas.