Prevalence of enteropatic arthritis in inflammatory bowel diseases

Inflammatory bowel diseases (IBD), mainly ulcerative colitis (UC) and Crohn's disease (CD) are frequently associated with extraintestinal symptoms. Arthritis is one of the most common extraintestinal findings. Enteropathic arthritis is a form of arthritis associated with chronic inflammatory bowel diseases. In this study, we aimed to determine the prevalence of enteropathic arthritis in patients with IBD and to evaluate the relationship of SpA in patients followed up with the diagnosis of IBD (CH and UC). The records of patients who applied to Tekirdağ Namık Kemal University Rheumatology and Gastroenterology Outpatient Clinic with the diagnosis of IBD between 2019-2021 were retrospectively analyzed and included in the study. 62 patients over 18 years of age who were followed up with the diagnosis of IBD were analyzed. The patients in our study were evaluated in terms of axial SpA and peripheral SpA according to the ASAS (Spondyloarthritis Evaluation Society) criteria. Patients' age, gender, age at diagnosis of IBD and SpA, inflammatory low back pain findings, dactylitis, peripheral arthritis, uveitis history, HLA-B27 analysis results, pelvic X-ray, sacroiliac joint MRI results, BASDAI scores were obtained by examining outpatient anamnesis notes and hospital electronic data system. . ASDAS-ESH and ASDAS-CRP values were calculated by recording the ESH, CRP and BASDAI score values obtained in previous outpatient clinic applications. 62 patients with a diagnosis of IBD were included in our study. 41 of the 62 patients were diagnosed with UC and 21 with CD. Eighteen (29%) of 62 patients with IBD were diagnosed with SpA. Of the patients diagnosed with SpA, 9 were male and 9 were female. Their ages ranged from 18 to 74, with a mean age of 49 ± 11.23 years. No statistically significant difference was found in terms of gender, male-female ratio (p=0.964). Nine (21.9%) of 41 patients with UC and 9 (42.8%) of 21 patients with CD were diagnosed with SpA. Low back/hip pain was present in 16 (88.9%) of IBD patients with SpA and 21 (47.7%) of IBD patients without SpA. Peripheral arthritis was present as the first initial symptom in 3 (16.7%) of the patients with SpA and IBD together, and in 1 (2.3%) of the IBD patients without SpA diagnosis. Heel pain was observed only in patients with SpA, and it was seen in 5 patients (27.8%). None of the patients had psoriasis, uveitis, urethritis/cervicitis. There was a family history in 9 (50%) of the IBD patients and in 2 (4.5%) of the patients without SpA diagnosis. There was a statistically significant difference between the two groups in terms of family history (p<0.05). In our study, the frequency of SpA in patients diagnosed with IBD was similar to the literature and was found to be 29%. It should be noted that a significant part of patients with IBD are associated with SpA. Delay in the diagnosis of enteropathic arthritis may cause functional impairment and disability in patients. Optimal treatment is possible by preventing the delay in the diagnosis of enteropathic arthritis. Therefore, patients with a diagnosis of IBD should be carefully evaluated in terms of findings such as inflammatory low back pain, arthritis, dactylitis, and enthesitis that may suggest SpA in the differential diagnosis.