Malaty Hoda M, Lo Grace Hsiao-Wei, Hou Jason K
Department of Medicine, Baylor College of Medicine.
Michael E DeBakey Veterans Affairs Medical Center.
Clin Exp Gastroenterol. 2017 Sep 27;10:259-263. doi: 10.2147/CEG.S136383. eCollection 2017.
Joint complaints such as spondyloarthritis and peripheral arthritis are the most common extraintestinal manifestations in patients with inflammatory bowel disease (IBD); however, the evaluation of these symptoms are poorly described.
To examine the clinical characteristics and prevalence of ankylosing spondylitis (AS) and other joint complaints among patients with IBD.
In a local cohort of patients diagnosed with IBD between 1996 and 2009, we performed a retrospective study at the Veterans Affairs Hospital. Patients with IBD were identified by International Classification of Diseases, Ninth Revision codes and confirmed by chart review. The occurrence of AS, peripheral arthritis, and other peripheral and axial joint symptoms were identified.
We identified 626 patients with IBD between ages 18 and 90 (90% males), of whom 57% had ulcerative colitis (UC), 74% were Caucasians, and the mean age at diagnosis was 54 (±16) years. Among the study population, 108 patients (17%) had at least one type of joint pain. Among these 17% with joint pain, 12% had AS, 43% had peripheral arthritis, 32% had chronic back pain without AS, and 13% had other types of joint pain. The overall prevalence of peripheral arthritis among patients with IBD was three times higher than that of AS (7% vs 2.1%, respectively, OR 3.5; 95% confidence interval [CI] 1.9-6.5; =0.001). There was no difference in the prevalence of AS or peripheral arthritis between patients with Crohn's disease and UC. The initial diagnosis of AS occurred after the initial diagnosis of IBD in 80% of patients within a mean (SD) period of 5.6 (±6) years.
Spondyloarthritis among patients with IBD is usually diagnosed after the initial diagnosis of IBD. No difference in the prevalence of AS or peripheral arthritis was observed by IBD type, age, or race. Recognition and understanding of these results will have important implications for the management of IBD patients with spondyloarthritis.
诸如脊柱关节炎和外周关节炎等关节问题是炎症性肠病（IBD）患者最常见的肠外表现；然而，对这些症状的评估描述甚少。
研究IBD患者中强直性脊柱炎（AS）及其他关节问题的临床特征和患病率。
在1996年至2009年间确诊为IBD的当地患者队列中，我们在退伍军人事务医院进行了一项回顾性研究。IBD患者通过国际疾病分类第九版编码识别，并经病历审查确认。确定AS、外周关节炎以及其他外周和轴向关节症状的发生情况。
我们确定了626例年龄在18至90岁之间的IBD患者（90%为男性），其中57%患有溃疡性结肠炎（UC），74%为白种人，诊断时的平均年龄为54（±16）岁。在研究人群中，108例患者（17%）至少有一种关节疼痛。在这17%有关节疼痛的患者中，12%患有AS，43%患有外周关节炎，32%患有无AS的慢性背痛，13%患有其他类型的关节疼痛。IBD患者中外周关节炎的总体患病率比AS高3倍（分别为7%和2.1%，OR 3.5；95%置信区间[CI] 1.9 - 6.5；P = 0.001）。克罗恩病患者和UC患者中AS或外周关节炎的患病率没有差异。80%的患者在IBD初始诊断后的平均（标准差）5.6（±6）年内确诊AS。
IBD患者中的脊柱关节炎通常在IBD初始诊断后确诊。IBD类型、年龄或种族对AS或外周关节炎的患病率无差异。认识和理解这些结果将对IBD合并脊柱关节炎患者的管理具有重要意义。
