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P183. Multidisciplinary approach in IBD patients with arthralgias: usefulness of a combined rheumatologic and gastroenterologic assessment in a prospective study

M. Ascolani1, M.S. Chimenti2, S. Onali1, P. Conigliaro2, E. Ballanti2, G. Collalti2, E. Calabrese1, E. Lolli1, C. Petruzziello1, F. Pallone1, R. Perricone2, L. Biancone1, 1Università di Roma Tor Vergata, Medicina dei sistemi, cattedra di Gastroenterologia, Roma, Italy, 2Tor Vergata, Medicina dei Sistemi, Rheumatology, allergology and clinical immunology Unit, Roma, Italy

Background

The prevalence of Enteropathic-related Spondyloarthritis (SpAe) in IBD shows marked variations (18–45%). Controlling “joint pain” in IBD is a relevant clinical issue, and the real prevalence of rheumatologic abnormalities may be underestimated by gastroenterologists. In a prospective study, we aimed to evaluate the prevalence and characteristics of articular manifestations in IBD patients (pts) with arthralgias, as assessed by a dedicated rheumatologist. Therapeutic changes after the combined assessment were evaluated.

Methods

From December 2012 to November 2013, all IBD pts referring articular pain to the IBD-dedicated gastroenterologist were referred to an experienced rheumatologist. Assessment was made according to current guidelines and data recorded in a common database. Statistic: paired T test. Data expressed as median (range).

Results

During the 12mos follow up, 1275 pts were assessed as outpatients in the IBD Unit. Arthralgias were referred by 93/1275 (7.3%) IBD pts, referred to the rheumatologist for proper assessment. Ulcerative colitis (UC) group included 38 pts: 11M, age 46 yrs (18–77), UC duration 10 yrs (0–47), UC inactive in all pts (Partial Mayo score <3). UC extent was total (n = 18; 47%), left-sided (n = 15; 40%) or distal (n = 5; 13%). Among these 38 pts, 8 (21%) were smokers, 11 (29%) ex-smokers, 4 (11%) had familial history of IBD. Crohn's disease (CD) group included 55 pts: 18M, age 49 yrs (20–89), CD duration 17 yrs (range 1–40), CD was inactive in 49 (89%), mildly active (CDAI 150–220) in 6 (11%). Montreal CD classification: B1 31 (56%), B2 22 (40%), B3 2 (4%), P5 (9%); L1 24 (44%), L2 8 (14%), L3 23 (42%), L4 2 (4%). In CD, 19 (35%) were smokers, 5 (9%) had familiar history of IBD. Among the 93 IBD pts with arthralgias, rheumatologic assessment diagnosed rheumatologic diseases in 33 (88%) UC and in 44 (80%) CD pts. In particular, a diagnosis of SpAe was made in 50 (54%) IBD pts (54% peripheral SpA, 24% axial SpA, 22% both), 24 (26%) Osteoarthritis, 6 (7%) Fybromialgia, 3 (3%) Gout, 3 (3%) Rheumatoid Arthritis, 2 (2%) Psoriatic Arthritis, while diagnosis was inconclusive in 5 (6%) pts. After rheumatological assessment, a higher percentage of IBD pts were treated with disease-modifying anti-rheumatic drugs (including anti-TNFs) (5.3% vs 15%, p = 0.03, RR 1.6) and/or with anti-COX2 (6.4% vs 27%; p < 0.0001; RR 2.3). Anti-TNFs use also significantly increased (19% vs 34%, p = 0.009; RR 1.8).

Conclusion

Multidisciplinary IBD care including rheumatologists may facilitate the diagnosis and management of arthralgias in IBD. A combined multidisciplinary approach may also lead to an early diagnosis and proper treatment of chronic and debilitating inflammatory arthritis.