Vladimirova Nora, Terslev Lene, Attauabi Mohamed, Madsen Gorm, Fana Viktoria, Wiell Charlotte, Døhn Uffe Møller, Bendtsen Flemming, Seidelin Jakob, Burisch Johan, Østergaard Mikkel
Copenhagen Center for Arthritis Research [COPECARE], Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
J Crohns Colitis. 2024 Aug 6;18(7):1053-1070. doi: 10.1093/ecco-jcc/jjae022.
Musculoskeletal [MSK] manifestations in patients with inflammatory bowel disease [IBD] are common and associated with poorer outcomes. Hence, early detection is important to optimally tailor treatment. We aimed to determine the prevalence and distribution of inflammatory lesions in peripheral joints and entheses in newly diagnosed IBD patients.
Patients with newly diagnosed IBD from a prospective population-based inception cohort were consecutively included. Data on MSK symptoms were collected by questionnaires and by structured rheumatological interview. Peripheral joints and entheses were assessed clinically and by ultrasound [US], using standardized definitions.
Of 110 included patients (mean age: 42 years, 40% male, 70 with ulcerative colitis [UC], 40 with Crohn's disease [CD]), a history of ≥1 peripheral musculoskeletal symptom was reported by 49%. Clinical examination revealed peripheral MSK manifestations in 56 [52.3%] patients; 29 [27.1%] had ≥1 tender and/or swollen joints and 49 [45.8%] ≥1 tender entheses. Small peripheral joints were predominantly affected. US found inflammation in ≥1 joint or enthesis in 52 [49.5 %] patients; 29 [27.4 %] had US synovitis in ≥1 joint, while 36 [34%] had US enthesitis. Fibromyalgia classification criteria were fulfilled in seven [7.9%] patients. There was no difference in clinical or US findings between patients with UC and CD, nor between patients with active and inactive IBD.
Half of the patients with newly diagnosed IBD had inflammation in their peripheral joints and/or entheses, documented by rheumatological clinical and US evaluations. This indicates a need for multidisciplinary collaboration to ensure an optimal therapeutic strategy for suppressing inflammation in all disease domains.
炎症性肠病（IBD）患者的肌肉骨骼（MSK）表现很常见，且与较差的预后相关。因此，早期检测对于优化治疗方案很重要。我们旨在确定新诊断的IBD患者外周关节和附着点炎症性病变的患病率和分布情况。
连续纳入来自一项基于人群的前瞻性起始队列中确诊的IBD患者。通过问卷调查和结构化风湿病访谈收集MSK症状数据。使用标准化定义，通过临床检查和超声（US）对外周关节和附着点进行评估。
在纳入的110例患者中（平均年龄：42岁，40%为男性，70例溃疡性结肠炎[UC]，40例克罗恩病[CD]），49%的患者报告有≥1种外周肌肉骨骼症状病史。临床检查发现56例（52.3%）患者有外周MSK表现；29例（27.1%）有≥1个压痛和/或肿胀关节，49例（45.8%）有≥1个压痛附着点。外周小关节受累为主。超声检查发现52例（49.5%）患者有≥1个关节或附着点炎症；29例（27.4%）患者≥1个关节有超声滑膜炎，36例（34%）有超声附着点炎。7例（7.9%）患者符合纤维肌痛分类标准。UC患者和CD患者之间以及活动期和非活动期IBD患者之间的临床或超声检查结果无差异。
通过风湿病临床和超声评估记录，新诊断的IBD患者中有一半在外周关节和/或附着点存在炎症。这表明需要多学科合作，以确保制定最佳治疗策略来抑制所有疾病领域的炎症。
