Vladimirova Nora, Møller Jakob, Attauabi Mohamed, Madsen Gorm, Seidelin Jakob, Terslev Lene, Gosvig Kasper Kjærulf, Siebner Hartwig Roman, Hansen Sanja Bay, Fana Viktoria, Wiell Charlotte, Bendtsen Flemming, Burisch Johan, Østergaard Mikkel
Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Am J Gastroenterol. 2025 Jan 1;120(1):225-240. doi: 10.14309/ajg.0000000000003039. Epub 2024 Aug 20.
In patients with inflammatory bowel disease (IBD), co-occurring spondyloarthritis (SpA) leads to poorer outcomes and impaired quality of life, highlighting the importance of early detection and effective treatment. This is the first study to assess the prevalence and distribution of axial symptoms and magnetic resonance imaging (MRI)-detected involvement of the spine and sacroiliac joints (SIJs) in early IBD.
Newly diagnosed patients with IBD from a prospective, population-based cohort were consecutively recruited. Rheumatological interview, clinical, ultrasound, and MRI assessment for SIJ and spine inflammatory and structural lesions were made using validated scoring methods and consensus definitions of axial SpA (axSpA).
Of 110 patients (ulcerative colitis: 70, Crohn's disease: 40, mean age of 42 years, and 40% male), 48 (44.9%) reported back and/or buttock pain, and 10 (9.1%) had inflammatory back pain. Seventeen (16.7%) patients had MRI findings indicative of axSpA; only 10 of these patients had axial symptoms. Inflammatory MRI lesions were present in SIJs and the spine of 27 (26.5%) and 30 (30.3%) patients, respectively. The Assessment of SpondyloArthritis International Society classification criteria for axSpA were met in 11 (10%) cases. MRI findings typical of axSpA were associated with peripheral joint and entheseal inflammation detected by ultrasound ( P = 0.04). No differences in clinical or imaging findings were found between patients with ulcerative colitis and Crohn's disease.
One-in-6 newly diagnosed patients with IBD had MRI findings indicative of axSpA. As 40% of these patients were asymptomatic, this suggests that axSpA is underdiagnosed in early IBD. Multidisciplinary collaboration is essential to ensure early detection of axial inflammation and to enable optimal therapy preventing future structural damage and disability.
在炎症性肠病（IBD）患者中，同时发生的脊柱关节炎（SpA）会导致更差的预后和生活质量受损，这凸显了早期检测和有效治疗的重要性。这是第一项评估早期IBD患者轴向症状的患病率和分布以及磁共振成像（MRI）检测到的脊柱和骶髂关节（SIJ）受累情况的研究。
连续招募来自一项前瞻性、基于人群队列的新诊断IBD患者。使用经过验证的评分方法和轴向SpA（axSpA）的共识定义，对SIJ和脊柱的炎症及结构病变进行风湿科访谈、临床、超声和MRI评估。
在110例患者中（溃疡性结肠炎：70例，克罗恩病：40例，平均年龄42岁，男性占40%），48例（44.9%）报告有背部和/或臀部疼痛，10例（9.1%）有炎性背痛。17例（16.7%）患者的MRI结果提示axSpA；这些患者中只有10例有轴向症状。分别有27例（26.5%）和30例（30.3%）患者的SIJ和脊柱存在炎性MRI病变。11例（10%）病例符合axSpA的国际脊柱关节炎评估协会分类标准。axSpA典型的MRI结果与超声检测到的外周关节和附着点炎症相关（P = 0.04）。溃疡性结肠炎和克罗恩病患者在临床或影像学表现上未发现差异。
六分之一的新诊断IBD患者有提示axSpA的MRI结果。由于这些患者中有40%无症状，这表明axSpA在早期IBD中未得到充分诊断。多学科合作对于确保早期发现轴向炎症并实现最佳治疗以防止未来结构损伤和残疾至关重要。
