Musculoskeletal findings and association with disease activity in patients with inflammatory bowel disease

There are two forms of inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD).IBD is a chronic, non-infectious inflammatory disease of the gastrointestinal tract with remission and exacerbations. Although IBD mainly affects the gastrointestinal system, it can also progress with extra-intestinal signs and symptoms such as joints, eye, skin, pulmonary and hepatobiliary system involvement. Musculoskeletal system is commonly involved in IBD. Musculoskeletal involvement is the most common extra-intestinal finding in patients with IBD and its prevalence ranges from %17 to %39. The average incidence is around %25. Musculoskeletal system involvements such as arthritis, arthralgia, enthesitis, mechanical low back pain, spondyloarthropathy, osteoporosis, fibromyalgia can be seen. Although the mechanisms of these involvements are not fully understood, it is stated that they are multifactorial. It has been suggested that common genetic and immunogenic mechanisms play a role in inflammation occurring in the joints and intestinal mucosa. The aim of this study is to evaluate the frequency of musculoskeletal involvement in IBD, to determine the factors affecting these involvements, and to determine whether they are associated with disease activity. In this study 80 patients, 18-60 years of age,who were followed up with the diagnosis of IBD in Adıyaman Training and Research Hospital Gastroenterology outpatient clinic were included.Patients' age, gender, smoking and alcohol use, BMI, family history, disease duration, frequency of attacks, and corticosteroid use were questioned. Laboratory parameters such as complete blood count, biochemistry, sedimentation and C-reactive protein (CRP) were examined. The gastrointestinal system involvement of the diseases was evaluated histopathologically.SEO Clinical Activity index was used to evaluate disease activity in UC and Harvey-Bradshaw Clinical Activity index was used in CD. Among the musculoskeletal system findings, the presence of peripheral arthropathy, ankylosing spondylitis (AS) and isolated sacroileitis were evaluated with physical examination and direct radiograph. Lunar BTXDual-Energy X-ray Absorptiometry (DEXA) device was used for the diagnosis of osteopenia and osteoporosis. Bone mineral density (BMD) measurements of all participants were performed. Of 80 patientsincluded in the study,64(%80) were ÜK and 16(%20) were CD. Of the study participants, 52 (%65) were male and 28 (%35) were female.The mean age of the patients was 37,61±11,12 years. Peripheral arthropathy was detected in 20%, AS in 8.8% and isolated sacroileitis in 22.5% of the patients. According to L1-L4 BMD measurements, %33,8 of patients had osteopenia and %27,5 of patients had osteoporosis. According to Femur neck BMD measurements, %20 of patients had osteopenia and %1,3 of patients had osteoporosis. CRP values were higher in Crohn's disease than in Ulcerative colitis.Femur neck BMD values were found to be lower in CD than in UC.A negative correlation was found between age and Femur neck BMD values in male patients. A significant correlation was found between osteopenia and distal colitis in UC patients, and a positive correlation was also found between osteoporosis and pancolitis.Lumbar DEXA groups (normal, osteopenic and osteoporotic) were found to be significantly higher in UC patients with a mild SEO disease activity index. Evaluating musculoskeletal involvement in Gastroenterology clinics, which are following UC and Crohn's patients, and referring them to Physical Medicine and Rehabilitation clinics will provide early diagnosis and treatment opportunities in terms ofmusculoskeletal involvement.It will also prevent the occurrence of complications by preventing the delay of treatment.