Abstract
To determine the prevalence, clinical and radiological characteristics of spondyloarthropathy (SpA) in patients with inflammatory bowel disease (IBD), to assess the association between HLA B27 and B51 and the extraintestinal symptoms and to evaluate whether IBD is associated with Behçet’s disease (BD). One hundred and sixty-two consecutive adult patients with established diagnosis of IBD as either Crohn’s disease (CD) or ulcerative colitis (UC) were evaluated. All the patients including those previously diagnosed with or without SpA had a complete rheumatologic examination and they were evaluated according to the European Spondyloarthropathy Study Group (ESSG) criteria for SpA and The International Study Group for Behçet’s disease criteria for BD. The demographic and clinical data were recorded on a standardized form. The radiographies were obtained in all the patients and computed tomography (CT) was performed in the patients with suspected pelvic radiographies and/or low back pain in the physical examination. Radiological evaluation was made according to the Modified New York criteria. HLA B27, B51 and anti-neutrophile cytoplasmic antigen (ANCA) were searched in all the patients. Of the 162 patients with IBD (mean age 41.48±11.63 years, male 60, female 102), 78 were CD and 84 were UC. The mean of the IBD duration was 54.92±50.32 months and SpA duration was 20.63±34.37 months. The prevalence of SpA and AS in IBD was 45.7 and 9.9%, respectively. Frequencies of SpA and AS, the difference between UC and CD were not significant. Spondylitis, enthesitis, peripheral arthritis, oral ulcer and uveitis were not different between UC and CD, but erythema nodosum was found significantly more common in the CD patients compared with UC patients (P=0.005). The duration of IBD and SpA was similar in both groups. As the IBD duration increased, the prevalence of SpA development decreased (rr=0.991, P=0.009). Of the IBD patients, 13.6% were asymptomatic for musculoskeletal manifestations of SpA and their sacroiliac radiographies and CTs showed grade 2 sacroiliitis. HLA B27, B51 and ANCA positivities were not different between the patients with UC and CD. HLA B27 was significantly more common in the patients with sacroiliitis, spondylitis, enthesitis, peripheral arthritis, erythema nodosum, uveitis (P<0.001) and oral ulcer (P=0.025). BD was diagnosed in none of the patients. ANCA positivity was found to be related with the presence of erythema nodosum and uveitis (P=0.001 and P=0.005). The prevalence of SpA and AS is higher in the prospectively evaluated patients with radiological studies than those in the previously published studies. There is a high prevalence of asymptomatic sacroiliitis in IBD. An early diagnosis of inflammatory arthritis in IBD patients may prevent a disability due to SpA and AS.
References
Baeten D, De Keyser F, Mielants H, Veys EM (2002) Ankylosing spondylitis and bowel disease. B Pract Res Clin Rheumatol 16:537–549
Smale S, Natt RS, Orchard TR, Russel AS, Bjarnason I (2001) Inflammatory bowel disease and spondyloarthropathy. Arthritis Rheum 44:2728–2736
Gravallese EM, Kantrowitz FG (1988) Arthritic manifestations of inflammatory bowel disease. Am J Gastroenterol 83:703–709
Schorr-Lesnick B, Brandt LJ (1988) Selected rheumatologic and dermatologic manifestations of inflammatory bowel disease. Am J Gastroenterol 83:216–223
Khan MA (2002) Update on spondyloarthropathies. Ann Intern Med 136:896–907
Kidd BI, Cawley MI (1988) Delay in diagnosis of spondylarthritis. Br J Rheumatol 27:230–232
Boyer GS, Templin DW, Bowler A, Lawrence RC, Heyse SP, Everett DF et al (1997) A comparison of patients with spondyloarthropathy seen in specialty clinics with those identified in a community wide epidemiologic study. Has the classic case misled us? Arch Intern Med 157:2111–2117
Spoorenberg A, van der Hejde D, de Klerk E, Dougados M, de Vlam K, Mielents H et al (1999) Relative values of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 26:980–984
Salvarani C, Vlachonikolis IG, van der Heijde DM, Fornaciari G, Macchioni P, Beltrami M et al (2001) Musculoskeletal manifestation in a population-based cohort of inflammatory bowel disease patients. Scand J Gastroenterol 36:1307–1313
de Vlam K, Mielants H, Cuvelier C, de Keyser F, Veys EM, de Vos M (2000) Spondyloarthropathy is underestimated in inflammatory bowel disease: prevalence and HLA association. J Rheumatol 27:2860–2865
Palm O, Moum B, Ongre A, Gran JT (2002) Prevalence of ankylosing spondylitis and other spondyloarthropathies among patients with inflammatory bowel disease: a population study (The IBSEN Study). J Rheumatol 29:511–515
Bernstein CN, Blanchard JF, Rawsthorne P, Yu N (2001) The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol 96:1116–1122
Gul A, Uyar FA, Inanc M, Ocal L, Barrett JH, Aral H et al (2002) A weak association of HLA-B*2702 with Behcet’s disease. Genes Immun 3:368–372
Houman H, Ben Dahmen F, Ben Ghorbel I, Chouaib S, Lamloum M, Kchir N et al (2001) Behcet’s disease associated with Crohn’s disease. Ann Med Interne (Paris) 152:480–482
Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A et al (1991) The European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathy. Arthritis Rheum 34:1218–1227
van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368
International Study Group for Behçet’s Disease: criteria for diagnosis of Behçet’s disease (1990) Lancet 335:1078–1080
Steer S, Jones H, Hibbert J, Kondeatis E, Vaughan R, Sanderson J et al (2003) Low back pain, sacroiliitis, and the relation with HLA-B27 in Crohn’s disease. J Rheumatol 30:518–522
Scarpa R, Del Puente A, D’Arienzo A, di Girolamo C, della Valle G, Panarese A (1992) The arthritis of ulcerative colitis: clinical and genetical aspects. J Rheumatol 19:373–377
Orchard TR, Wordsworth BP, Jewell DP (1998) Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut 42:387–391
Scott WW, Fishman EK, Kuhlman JE, Caskey CI, O’Brien JJ, Walia GS et al (1990) Computed tomography evaluation of the sacroiliac joints in Crohn’s disease. Radiologic/clinical correlation. Skeleton Radiol 19:207–210
Queri R, Maiz O, Intxausti J, de Dios JR, Belzunegui J, Gonzalez C et al (2000) Subclinic sacroiliitis in inflammatory bowel disease: a clinical and follow-up study. Clin Rheumatol 19:445–449
McEniff N, Eustace S, McCharthy C, O’Malley M, O’Morain CA, Hamilton S (1995) Asymptomatic sacroiliitis in inflammatory bowel disease. Assessment by computed tomography. Clin Imaging 19:258–262
Leirisalo-Repo M, Turunen U, Stenman S, Helenius P, Seppala K (1994) High frequency of silent inflammatory bowel disease in spondyloarthropathy. Arthritis Rheum 37:23–31
Mielants H, De Vos M, Cuvelier C, Veys EM (1996) The role of gut inflammation in the pathogenesis of spondyloarthropathies. Acta Clin Belg 51:340–349
Torok HP, Glas J, Gruber R, Brumberger V, Strasser C, Kellner H et al (2004) Inflammatory bowel disease-specific autoantibodies in HLA-B27-associated spondyloarthropathies: increased prevalence of ASCA and pANCA. Digestion 70:49–54
Picco P, Gattorno M, Vignola S, Barabino A, Marazzi MG, Bondi E et al (1999) Clinical and biological characteristics of immunopathological disease-related erythema nodosum in children. Scand J Rheumatol 28:27–32
Gordon LK, Eggene M, Holland GN, Weisz JM, Braun J (1998) pANCA antibodies in patients with anterior uveitis: identification of a marker antibody usually associated with ulcerative colitis. J Clin Immunol 18:264–271
Oguz FS, Ocal L, Diler AS, Ozkul H, Asicioglu F, Kasapoglu E et al (2004) HLA B-27 subtypes in Turkish patients with spondyloarthropathy and healthy controls. Dis Markers 20:309–312
Pirim I, Atasoy M, Ikbal M, Erdem T, Aliagaoglu C (2004) HLA class I and II genotyping in patients with Behcet’s disease: a regional study of eastern part of Turkey. Tissue Antigens 64:293–297
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Turkcapar, N., Toruner, M., Soykan, I. et al. The prevalence of extraintestinal manifestations and HLA association in patients with inflammatory bowel disease. Rheumatol Int 26, 663–668 (2006). https://doi.org/10.1007/s00296-005-0044-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-005-0044-9