Zabotti Alen, Cabas Nicola, Cacioppo Sofia, Zoratti Caterina, Giovannini Ivan, Berretti Debora, Luchetti Michele Maria, De Vita Salvatore, Quartuccio Luca, Terrosu Giovanni, Marino Marco
Division of Rheumatology, Department of Medicine (DMED), Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Rheumatology Institute, University of Udine, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy.
Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Rheumatol Ther. 2024 Oct;11(5):1321-1331. doi: 10.1007/s40744-024-00709-7. Epub 2024 Aug 17.
Inflammatory bowel disease (IBD)-related arthritis is recognized as the most prevalent extraintestinal manifestation (EIM) of IBD. The objective of this study was to determine the prevalence and characteristics of undiagnosed IBD-related arthritis and to compare two screening questionnaires, DETection of Arthritis in Inflammatory boweL diseases (DETAIL) and IBd Identification of Spondyloarthritis Questionnaire (IBIS-q), for early disease detection.
Between April and October 2023, both the DETAIL and IBIS-q questionnaires were administered to consecutive IBD outpatients visiting the University Hospital of Udine, Italy. During routine gastroenterology evaluations, patients aged > 18 years with Crohn's disease (CD) or ulcerative colitis (UC) were requested to complete both questionnaires. Subsequently, all patients who completed the questionnaires underwent a blinded rheumatological evaluation within 2 weeks. Patients with a previous diagnosis of IBD-related SpA were then excluded.
Overall, 203 patients were enrolled, of whom 26 were excluded because of a prior diagnosis of inflammatory arthritis. Among the remaining 177 patients, 10/177 (5.6%) received a new diagnosis of IBD-related arthritis. The median duration of symptoms before diagnosis was 4 (IQR 1.8-10.5) months. Imaging-confirmed enthesitis was the predominant pattern in 8 out 10 cases (80%, with 8 out 8 lacking concomitant peripheral arthritis), axial involvement in 1 out 10 cases (10%), and peripheral arthritis in 1 out 10 cases (10%). The DETAIL questionnaire exhibited higher specificity, but lower sensitivity compared to the IBIS-q, with a sensitivity of 40.0% (12.2-73.8) and specificity of 84.4% (78.0-89.6) versus a sensitivity of 70.0% (34.8-93.3) and specificity of 74.3% (66.9-80.7). Both questionnaires performed less effectively than in other studies.
This study highlights a significant proportion of undiagnosed IBD-related arthritis (5.6%). Enthesitis emerged as the predominant pattern of newly diagnosed arthritis in our cohort, likely due to the recent onset of symptoms. Our study underscores the importance of entheseal involvement in early IBD-related arthritis and the importance of incorporating entheseal involvement into screening questionnaires.
炎症性肠病（IBD）相关关节炎被认为是IBD最常见的肠外表现（EIM）。本研究的目的是确定未确诊的IBD相关关节炎的患病率和特征，并比较两种筛查问卷——炎症性肠病关节炎检测问卷（DETAIL）和IBD脊柱关节炎识别问卷（IBIS-q），以进行疾病早期检测。
2023年4月至10月期间，意大利乌迪内大学医院对连续就诊的IBD门诊患者同时发放了DETAIL问卷和IBIS-q问卷。在常规胃肠病学评估期间，年龄大于18岁的克罗恩病（CD）或溃疡性结肠炎（UC）患者被要求完成这两份问卷。随后，所有完成问卷的患者在2周内接受了盲法风湿病评估。既往诊断为IBD相关脊柱关节炎的患者随后被排除。
总体而言，共纳入203例患者，其中26例因先前诊断为炎性关节炎而被排除。在其余177例患者中，10/177（5.6%）被新诊断为IBD相关关节炎。诊断前症状的中位持续时间为4（四分位间距1.8 - 10.5）个月。影像学确诊的附着点炎是10例中的8例（80%）的主要表现形式（其中8例均无并发外周关节炎），10例中的1例（10%）有轴向受累，10例中的1例（10%）有外周关节炎。与IBIS-q相比，DETAIL问卷表现出更高的特异性，但敏感性较低，其敏感性为40.0%（12.2 - 73.8），特异性为84.4%（78.0 - 89.6），而IBIS-q的敏感性为70.0%（34.8 - 93.3），特异性为74.3%（66.9 - 80.7）。两份问卷的表现均不如其他研究有效。
本研究突出了相当一部分未确诊的IBD相关关节炎（5.6%）。在我们的队列中，附着点炎是新诊断关节炎的主要表现形式，可能是由于症状近期出现。我们的研究强调了附着点受累在早期IBD相关关节炎中的重要性，以及将附着点受累纳入筛查问卷的重要性。
