Achilles enthesopathy and vitamin D in inflammatory bowel disease

Ulcerative Colitis (UC) and Chron's Disease (CD) may be complicated with extraintestinal manifestations (EIM). One of the most common EIM is spondyloarthropathies. Enthesopathy is a cardinal feature of spondyloarthropathy (SpA). Patients having enthesopathy diagnosed by magnetic resonance imaging and ultrasonography (USG) are generally asymptomatic. Therefore, radiologic imaging systems become widely used in the diagnosis of enthesopathy. Reliability of USG in the diagnosis of enthesopathy is proved in many studies. Vitamin D (Vit D) unlike other vitamins is accepted as a hormone because of its beeing synthesised in human body. It is unknown whether there is a relation between Vit D level and enthesopathy, or not. We planned to determine enthesopathy by USG in the achilles enthesis where enthesopathy is seen mostly and to study Vit D level. Thus the present study aimed to investigate the relation between enthesopathy, Vit D level and clinical, endoscopic and labarotory features of IBD. The study consisted of 100 IBD (52 UC and 48 CD) patients and 30 healthy volunteers. In patient group there was 51 men ( mean age 37.2±11.4), 49 women (mean age 40.1±12,2). The age and the gender profile of control group is similar to patient's group. In control group, there was no enthesopathy but entesopathy was diagnosed in 25 (25%) patients. Out of them who had sacroileitis were further evaluated and 6 patients were diagnosed as ankylosing spondylitis and their treatment was modified. OMERACT score was significantly higher in patients than control group (p<0.001). However there was no difference between UC and CD groups. When subgroup analysis of patients according to their clinical activity was done, OMERACT score was statistically higher in patients with active disease (p=0.044). There was no difference between control group and patients for Vit D levels. Although CH group seems to be having lower Vit D levels compared to UC group, this wasn't statistically important. When patients were grouped according to their disease activity a negative correlation was noted between Vit D level. In conclusion; the frequency and OMERACT score level of achilles enthesopathy were higher in IBD patients, particularly in active diasese. USG can be usefull in the diagnosis of asymptomatic IBD related SpA patients. Vit D level was not statistically different between patients and control group but it was lower in patients with clinically active disease.There is strong need for more studies aiming to determine the role of Vit D in the treatment and follow up IBD these patients. Key words: Inflammatory bowel disease, achilles enthesopathy, Vitamin D