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P294. Back pain in inflammatory bowel disease patients

L. Brakenhoff1, R. van den Berg2, F. van Gaalen2, A. van der Meulen-de Jong1, T. Huizinga2, D. van der Heijde2, D. Hommes3, H. Fidder4, 1Leiden University Medical Center, Gastroenterology and Hepatology, Leiden, Netherlands, 2Leiden University Medical Center, Rheumatology, Leiden, Netherlands, 3University of California Los Angeles, Center for Inflammatory Bowel Diseases, Los Angeles, United States, 4University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands

Background

Axial and peripheral arthropathies are the most common extraintestinal manifestation in patients with inflammatory bowel diseases (IBD). We characterized axial complaints in IBD patients and classified these complaints according to the ASAS axial spondyloarthritis (axSpA) criteria.

Methods

In total, 138 IBD patients (77% Crohn's disease [CD], 23% ulcerative colitis [UC]) with daily back pain for ≥3 months and/or peripheral joint pain and/or joint swelling during the last year were included. A complete rheumatologic examination was performed. Inflammatory back pain (IBP) was defined according to the ASAS criteria. axSpA was defined according to the ASAS criteria in patients with age at onset back pain <45 years. The modified New York criteria were used to classify patients as ankylosing spondylitis (AS). Isolated sacroiliitis was defined as sacroiliitis without involvement of the spine based on radiograph or MRI. CRP and ESR were determined and HLA-B27 was typed.

Results

Of the 138 patients, 66 patients (71% CD, 35% male) reported back pain. The mean age of the patients with back pain was 44.8±13.9 years. The mean age at onset back pain was 38.6±15.3 years and the mean duration was 6.2±9.3 years. The majority of patients (82%) reported pain in the lumbar spine. Back pain developed after IBD diagnosis in 79% patients. The minority of patients (35%) reported an association between onset back pain and IBD activity. Mean CRP (n = 66) and ESR (n = 65) were 7.3±12.2 and 13.0±13.7, respectively. Six (9%) patients were HLA-B27 positive (5 CD). Almost half of the patients (47%) fulfilled the ASAS criteria for IBP. Isolated sacroiliitis on radiograph was found in 2 (3%) patients. Forty (61%) patients reported onset of back pain <45 years, of which 4 (10%) patients could be classified as axSpA. Three of the 4 axSpA patients fulfilled the criteria for AS. There were no differences in gender, age, IBD duration, mean age at onset and mean duration back pain, onset back pain pre/post IBD diagnosis, association with IBD activity, physical examination (modified Schober, chest expansion, lateral flexion), mean CRP, mean BSE, HLA-B27 positivity and type of back pain (IBP/non-IBP) between CD and UC patients.

Conclusion

More than half of the IBD patients with chronic back pain (≥3 months) have age at onset of back pain <45 years. Only few patients fulfill the ASAS criteria for axSpA. Axial complaints are similar between CD and UC.