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P196. Magnetic resonance imaging of the hands and knees in inflammatory bowel disease patients with arthralgia

L. Brakenhoff1, W. Stomp2, F. van Gaalen3, H. Fidder4, J. Bloem2, D. van der Heijde3, M. Reijnierse2, D. Hommes5, 1Leiden University Medical Center, Gastroenterology and Hepatology, Leiden, Netherlands, 2Leiden University Medical Center, Radiology, Leiden, Netherlands, 3Leiden University Medical Center, Rheumatology, Leiden, Netherlands, 4University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands, 5University of California Los Angeles, Center for Inflammatory Bowel Diseases, Los Angeles, United States


Arthralgia (joint pain without clinical synovitis) frequently occurs in inflammatory bowel disease (IBD) patients, resulting in a reduced quality of life compared to those without arthralgia. The underlying cause of arthralgia in IBD is unknown. In this study we assess whether subclinical inflammatory changes can be detected on MRI in IBD patients with arthralgia.


Painful hand (MCP/PIP/DIP) or knee joints for a duration of more than 6 weeks continuously in 15 young (<45years) IBD patients, 12 Crohn's disease and 3 ulcerative colitis, were scanned on a 1.5T extremity MRI. The same joints were scanned in a control group of 15 IBD patients without joint complaints who were matched for type and disease duration of IBD, gender and age. MR imaging was performed according to a standard arthritis protocol. MR images were evaluated by two musculoskeletal radiologists in consensus for the presence of inflammatory and structural changes.


The mean age was 37.7±5.4 years for arthralgia patients and 39.3±5.3 years for the controls. MR imaging of the hand, including either MCP and PIP or PIP and DIP joints, was performed in 11 patients and matched controls, MRI of the knee in 4 patients and matched controls. In total 57 joints, 53 hand joints and 4 knee joints, were evaluated in both groups. Enthesitis was seen in three of the MCP joints of two arthralgia patients (5.3% of all painful joints) and in none of the control group (p = 0.24). A small amount of subchondral bone-marrow edema was seen in the metacarpal head of two controls (3.5% of total joints, p = 0.50). In one painful knee joint fluid and synovitis was appreciated (1.8%, p = 1.00), no abnormalities were observed in the matched controls (p = 1.00).


This is the first study investigating the presence of anatomical changes on MRI in painful hand or knee joints in IBD patients with arthralgia without clinical arthritis or enthesitis by using MRI. Subclinical inflammation was present in one joint and enthesitis in three joints of arthralgia IBD patients on MRI. However, this was not statistically significant different from non-painful joints of IBD patients without arthralgia. No anatomical substrate was found for arthralgia in IBD patients.