Case-control Study on Dactylitis, Enthesitis, and Anterior Uveitis in Spondyloarthritis Associated with Inflammatory Bowel Diseases: Role of Coexistent Psoriasis

Fabrizio Cantini; Laura Niccoli; Carlotta Nannini; Emanuele Cassarà; Olga Kaloudi; Fernando Rizzello; Paolo Gionchetti

doi:10.3899/jrheum.161518

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Table 1A.

Reported frequency of dactylitis, enthesitis, anterior uveitis, and B27 positivity in patients with IBD-SpA in 7 studies. The reported association with psoriasis is also indicated. Data are n (%) unless otherwise indicated.

Conditions Measured	Orchard¹⁹, 1998 ^‡	De Vlam¹¹, 2000	Salvarani¹², 2001^*	Palm¹³, 2002	Generini¹⁸, 2004 ^†	Turkcapar⁸, 2006	Pérez Alamino¹⁰, 2011
Overall IBD-SpA, n	107	40	53	88	24	90	45
Dactylitis	NA	1 (2.5)	3 (5.6)	6 (6.8)	NA	0 (0)	7 (15.5)
Enthesitis	NA	7 (17.5)	16 (30.1)	11 (12.5)	16 (66.6)	81 (90)	7 (15.5)
Uveitis	20 (18.6)	NA	NA	7 (7.9)	NA	23(25.5)	NA
B27	NA	7 (17.5)	5 (3.6)	20 (22.7)	NA	47 (52.2)	NA
Psoriasis	NA	4 (10)	NA	4 (4.5)	NA	NA	NA
UC-SpA, n	59	13 (32.5)	NA	54	0	43	NA
Dactylitis, n	NA	0	NA	NA	NA	0 (0)	NA
Enthesitis	NA	2 (15.4)	NA	NA	NA	39 (90.7)	NA
Uveitis	10 (16.9)	NA	NA	NA	NA	8 (18.6)	NA
CD-SpA, n	48	27 (67.5)	NA	34	24	47	NA
Dactylitis	NA	1 (3.7)	NA	NA	NA	0 (0)	NA
Enthesitis	NA	5 (18.5)	NA	NA	16 (66.6)	42 (89.4)	NA
Uveitis	10 (20.8)	NA	NA	NA	NA	15 (31.9)	NA
Followup, mos	120	NA	NA	60	18	20.63 ± 34.3	NA

↵* IBD group included 3 patients with indeterminate colitis.
↵‡ Data are related to patients with peripheral IBD-SpA.
↵† Enthesitis was assessed both clinically and by ultrasound examination. IBD: inflammatory bowel disease; SpA: spondyloarthritis; UC: ulcerative colitis; CD: Crohn disease; NA: not available.

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Table 1B.

Reported frequency of dactylitis, enthesitis, anterior uveitis, and B27 positivity in patients with IBD-SpA in 7 more studies. The reported association with psoriasis is also indicated. Data are n (%) unless otherwise indicated.

Conditions Measured	Shivashankar^20,21, 2012, 2013	Al-Jarallah⁹, 2013	Zippi¹⁴, 2014	Kamo¹⁵, 2015^**	Isene¹⁶, 2015	Subramaniam¹⁷, 2015^**	Peluso²², 2016
Overall IBD-SpA, n	72	45	240	46	99	140	78
Dactylitis	NA	2 (4.4)	NA	7 (15.2)	NA	6 (4.3)	12 (15.4)
Enthesitis	49 (68)	7 (15.5)	NA	15 (32.6)	NA	24 (17.1)	NA
Uveitis	24 (33.3)	NA	26 (10.8)	1 (2.1)	10 (10.1)	8 (5.7)	NA
B27	NA	NA	NA	NA	NA	NA	NA
Psoriasis	23 (31.9)	NA	NA	NA	NA	8 (5.7)	NA
UC-SpA, n	40	27	169	NA	51	44	34
Dactylitis, n	NA	2 (7.4)	NA	NA	NA	3 (6.8)	2 (5.9)
Enthesitis	29 (72.5)	6 (22.2)	NA	NA	NA	6 (13.6)	NA
Uveitis	12 (30)	NA	10 (5.9)	NA	5 (9.8)	1 (2.3)	NA
CD-SpA, n	32	18	71	NA	48	96	44
Dactylitis	NA	0 (0)	NA	NA	NA	3 (3.1)	10 (22.7)
Enthesitis	24 (72)	1 (5.5)	NA	NA	NA	18 (18.8)	NA
Uveitis	12 (37.5)	NA	16 (22.5)	NA	5 (10.4)	7 (7.3)	NA
Followup, mos	480	65 ± 58	NA	NA	120	NA	NA

↵** Questionnaire-based survey. IBD: inflammatory bowel disease; SpA: spondyloarthritis; UC: ulcerative colitis; CD: Crohn disease; NA: not available.

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Table 2.

Demographic and clinical features in 88 IBD-SpA patients compared with 176 controls.

Feature	IBD-SpA	Overall SpA	PsA	AS	Nr-axSpA	p
N (%) of patients
Overall	88	176	97 (55.1)	47 (26.7)	32 (18.2)
UC	29 (33)
CD	59 (67)
IBD + psoriasis	14 (16)
UC + psoriasis	3 (13.7)
CD + psoriasis	11 (18.6)
Age, yrs, mean ± SD
Overall	47.66 ± 15.09	46.35 ± 24.88	52 ± 10.42	38 ± 9.21	34 ± 8.43	0.650
UC	51.07 ± 11.46
CD	45.67 ± 17.05
B27+, n (%)	10 (11.3)	70 (39.8)	14 (14.4)	43 (91.4)	13 (40.6)	< 0.001
Axial	7 (70)
Mixed	3 (30)
AxSpA, n (%)	46 (52)	88 (50)	9 (9.2)	47 (100)	32 (100)	0.828
UC	15 (52)
CD	31 (52.5)
Overall peripheral SpA, n (%)	29 (33)	62 (35)	62 (64)	0	0	0.819
Oligoarticular	26 (90)	41 (66)	41 (66)	0	0
Polyarticular	3 (10)	21 (34)	21 (34)	0	0
Mixed, n (%)	13 (15)	24 (14)	24 (25)	0	0	0.950
Disease duration, mos
Overall	60.05 ± 54.66	43.21 ± 28.34	63.25 ± 14.65	67.33 ± 24.16	23.26 ± 4.15	0.001
UC	76.28 ± 49.87					< 0.001
CD	51.98 ± 55.44					0.116
Dactylitis, n (%)
Overall	4 (4.5)	30 (17.4)	22 (22.6)	4 (8.5)	4 (12.5)	0.008
UC	1/29 (3.4)
CD	3/59 (5.1)
IBD/psoriasis+	3/14 (21.4)					0.960
IBD/psoriasis-negative	1/74 (1.3)					0.001
Enthesitis, n (%)
Overall	16 (18.1)	78 (44.3)	55 (56.7)	11 (23.4)	12 (37.5)	< 0.001
UC	2 (6.9)					< 0.001
CD	14 (23.7)					0.008
IBD/psoriasis+	7 (50)					0.895
IBD/psoriasis-negative	9 (12.1)					< 0.001
Anterior uveitis, n (%)
Overall	3 (3.4)	26 (14.7)	11 (11.3)	11 (23.4)	4 (11.4)	0.010
B27+	2 (66.6)	19/26 (73)	4/11 (36.3)	9/11 (81.8)	2/4 (50)	0.655
UC	1 (3.4)					0.169
CD	2 (3.3)					0.035
IBD/psoriasis+	0					0.253
IBD/psoriasis-negative	3 (4.0)					0.028
Followup, mos	96.23 ± 12.4	101.11 ± 34.22				0.456

IBD: inflammatory bowel disease; SpA: spondyloarthritis; PsA: psoriatic arthritis; AS: ankylosing spondylitis; axSpA: axial SpA; nr-axSpA: nonradiographic axSpA; UC: ulcerative colitis; CD: Crohn disease.

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Table 3.

Frequency of dactylitis, enthesitis, anterior uveitis, and HLA-B27 positivity in patients with IBD-SpA with and without coexistent psoriasis. Data are n (%) unless otherwise indicated.

Clinical Feature	Overall UC-SpA	Overall CD-SpA	p	IBD-SpA with Psoriasis	IBD-SpA without Psoriasis	p
No. patients	29	59		14	74
Dactylitis	1 (3.4)	3 (5.1)	0.843	3 (21.4)	1 (1.3)	0.009
Enthesitis	2 (6.9)	14 (23.7)	0.103	7 (50)	9 (12.1)	0.003
Anterior uveitis	1 (3.4)	2 (3.3)	0.541	0	3 (4.0)	0.95
HLA-B27+	1 (3.4)	9 (15.2)	0.199	2 (14.2)	8 (10.8)	0.969