Date Published: April 30, 2019
Publisher: Public Library of Science
Author(s): Aimee Hiller, Luc Biedermann, Nicolas Fournier, Matthias Butter, Stephan R. Vavricka, Adrian Ciurea, Gerhard Rogler, Michael Scharl, Pal Bela Szecsi.
Extraintestinal manifestations (EIM) involving joints, skin, eyes and liver represent an important problem in the treatment of IBD patients. The aim of this study was to identify factors that are associated with the occurrence of joint EIM and therefore allow an early diagnosis and guide medical treatment.
We studied clinical and epidemiological data from 3298 patients included in the Swiss IBD Cohort Study (SIBDCS), 1860 suffered from Crohn’s disease (CD) and 1438 from ulcerative colitis or IBD unclassified (UC/IBDU).
We found female gender as well as a longer disease duration and activity (specified as CDAI or MTWAI, respectively) to be related to the appearance of arthritis/arthralgia, but also sacroiliitis/ankylosing spondylitis in IBD patients. IBD patients with arthritis/arthralgia or sacroiliitis/ankylosing spondylitis were more often treated with anti-TNF and patients with arthritis/arthralgia underwent more often IBD-related surgeries. We revealed that eye or skin EIM were more frequent in patients with arthritis/arthralgia or sacroiliitis/ankylosing spondylitis. In multivariate analysis, we confirmed female gender, longer disease duration, IBD-related surgery, presence of other EIM and treatment with anti-TNF to be independent risk factors for the onset of arthritis/arthralgia in CD and UC/IBDU patients.
In this study, we demonstrated that markers for a more severe disease course were associated with the onset of joint EIM in IBD patients. Our data suggest that in particular females under anti-TNF treatment and patients suffering from non-joint and/or IBD-related surgery should be close and carefully monitored for presence of arthritis or sacroiliitis/ankylosing spondylitis.
Up to 47% of all inflammatory bowel disease (IBD) patients suffer from extraintestinal manifestations (EIM) [1–3]. Musculoskelettal manifestations in general are the most common EIM in IBD patients with peripheral arthritis being the most frequent subtype [2, 3]. It is obvious that patients with a high-risk profile for such EIM should be closely monitored (as well as treated early). Other organs affected by the intestinal disease are skin, bile duct and eyes . EIM may occur before the actual intestinal disease is diagnosed [1–3]. Furthermore, presence of EIM plays an important role in a patient’s quality of life [4–6].
In this study, we aimed to find epidemiologic and clinical risk factors for the occurrence of arthritis/arthralgia in patients suffering from IBD. We found that females are more likely to develop arthritis/arthralgia regardless whether they suffer from CD or UC. This observation is in good accordance with previous data from the SIBDCS, where 50% of the female CD patients, but only 34% of male CD patients suffered from any EIM [1, 18]. Male IBD patients however, more commonly present with axial arthropathies than female patients [3, 19]. Our study has now analyzed the presence of EIM in more detail and focused on arthritis/arthralgia and, in a second step, on the subgroup of patients with sacroiliitis/ankylosing spondylitis.