Giovannini Ivan, Cabas Nicola, Marino Marco, Tullio Annarita, Tinazzi Ilaria, Variola Angela, Cicciò Carmelo, Cinzia Fabro, Debora Berretti, Zuiani Chiara, Girometti Rossano, Quartuccio Luca, Zabotti Alen, Cereser Lorenzo
Rheumatology Clinic, Rheumatology Institute, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.
Department of Gastroenterology, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy.
Rheumatol Ther. 2025 Feb;12(1):99-108. doi: 10.1007/s40744-024-00728-4. Epub 2024 Dec 14.
Inflammatory bowel disease (IBD) related arthritis is the most prevalent extraintestinal manifestation (EIM) of IBD, ranging between 10 and 39%. Magnetic resonance enterography (MRE) is used to assess small bowel disease involvement in Crohn's disease (CD) and can detect signs of sacroiliitis in up to 23.5% of patients. The predicting role of sacroiliitis detected on MRE is still unknown. The aim of this study is to evaluate the predictive role of sacroiliitis at MRE and other clinical features for IBD-related arthritis development in a cohort of adult patients with CD.
Between December 2012 and May 2020, consecutive patients with CD who performed MRE were enrolled in the study. Patients with a previous diagnosis of IBD-related arthritis were excluded. A baseline demographics and clinical characteristics of the patients were retrospectively collected. The identification of new-onset IBD-related arthritis events during the follow-up was based on rheumatological clinical diagnosis and fulfillment of the ASAS classification criteria.
Ninety-five patients, mean age 43.9 years (standard deviation [SD] ± 16.6), 52.6% female were enrolled in the study with a median follow-up of 83 months (Q25:75 25:143). Six out 95 (6.3%) developed IBD-related arthritis with a mean time of 11 months (SD ± 16.8). Sacroiliitis detected on MRE was not associated with an increased risk of IBD-related arthritis (odds ratio [OR] = 2.12 [95% confidence interval (CI) 0.36, 12.53, p = 0.408]). In contrast, the presence of arthralgia and EIMs were found to be a predictor for IBD-related arthritis development (OR = 84.0 [95% CI 8.18, 862.39, p < 0.0001] and OR = 7.37 [95% CI 1.25, 43.32, p = 0.027], respectively).
This study highlights that sacroiliitis, as assessed by MRE, was not associated with the development of IBD-related arthritis, whereas extraintestinal manifestations and arthralgia were significantly associated with later IBD-related arthritis development in patients with CD.
炎症性肠病（IBD）相关关节炎是IBD最常见的肠外表现（EIM），发生率在10%至39%之间。磁共振小肠造影（MRE）用于评估克罗恩病（CD）患者的小肠疾病累及情况，并且在高达23.5%的患者中可检测到骶髂关节炎迹象。MRE检测到的骶髂关节炎的预测作用仍不明确。本研究的目的是评估在一组成年CD患者中，MRE检测到的骶髂关节炎及其他临床特征对IBD相关关节炎发生的预测作用。
在2012年12月至2020年5月期间，连续纳入进行MRE检查的CD患者。排除先前诊断为IBD相关关节炎的患者。回顾性收集患者的基线人口统计学和临床特征。随访期间新发IBD相关关节炎事件的认定基于风湿病临床诊断和ASAS分类标准的满足情况。
95例患者纳入研究，平均年龄43.9岁（标准差[SD]±16.6），女性占52.6%，中位随访时间83个月（四分位数间距25:75为25:143）。95例中有6例（6.3%）发生IBD相关关节炎，平均时间为11个月（SD±16.8）。MRE检测到的骶髂关节炎与IBD相关关节炎风险增加无关（比值比[OR]=2.12[95%置信区间（CI）0.36,12.53，p=0.408]）。相反，发现关节痛和EIMs是IBD相关关节炎发生的预测因素（OR分别为84.0[95%CI 8.18,862.39，p<0.0001]和OR=7.37[95%CI 1.25,43.32，p=0.027]）。
本研究强调，MRE评估的骶髂关节炎与IBD相关关节炎的发生无关，而肠外表现和关节痛与CD患者后期IBD相关关节炎的发生显著相关。
