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P213. High prevalence of subclinical ultrasonographic synovitis in patients with inflammatory bowel disease

E. Vicente1, S. Pérez2, M. Chaparro3, F. Rodríguez-Salvanés4, S. Castañeda1, J.P. Gisbert3, 1Hospital La Princesa, IIS-P, Rheumatology Department, Madrid, Spain, 2Fundación Jiménez Díaz, Rheumatology Department, Madrid, Spain, 3Hospital Universitario de La Princesa, IP and CIBERehd, Gastroenterology Unit, Madrid, Spain, 4Hospital La Princesa, IIS-P, Epidemiologic Research Unit, Madrid, Spain

Background

A relevant proportion of inflammatory bowel disease (IBD) patients suffers musculoskeletal manifestations, such as peripheral arthritis, axial disease and entesitis. Power doppler ultrasonography (PDUS) has been shown to have higher sensitivity than physical examination detecting synovitis, so it may be useful to identify subclinical joint alterations and to establish an early diagnosis of arthritis associated with IBD.

Objective: To evaluate the prevalence of synovitis by PDUS examination in IBD patients without musculoskeletal signs and symptoms and to identify predictive factors for the development of synovitis.

Methods

IBD patients from our out-patients clinic without musculoskeletal symptoms were prospectively included during 2012. Blinded gastroenterological, rheumatological and PDUS evaluation were performed. Clinical characteristics and physical activities were evaluated, and musculoskeletal clinical examination was performed. PDUS evaluation consisted of the detection of grey scale (GS) synovitis and synovial PDUS signal in 44 joints (bilateral sternoclavicular, acromioclavicular, glenohumeral, elbow, carpal, MCP, PIP, knee, ankle and MTP joints) using a LOGIQ7 General Electric machine with a 12-MHz linear array transducer. US variables were scored binary (present/absent) and semiquantitatively. The intra-reader agreement for US was estimated in all images obtained.

Results

Twenty-three IBD patients (56% male), 9 Crohn's disease and 14 ulcerative colitis, have been included so far. Clinical variables: age 42±12 years, evolution time 9 years (range: 0.1–33), CDAI 28±21, Mayo index 0.4±1, Disease Modifying Anti-Rheumatic Drugs therapy in 91.3% for 5.5±5 years, ESR 12±8.8 mm/h and CRP 0.12±0.1 mg/dL. GS joint effusion and synovial hypertrophy in at least 1 joint were present in 91.3% and 100%, respectively, with poly-articular (≥5 joints) involvement in 48% and 74%, respectively, which was mostly mild or moderate. Mild or moderate PDUS signal was positive in 48% of patients. Joint effusion and synovial hypertrophy were more frequent in MTF, MCF and carpal joints, and PDUS in carpal and knee joints. We found no association between PDUS variables and clinical and analytical IBD variables. The intra-reader agreement was high (0.8 intra-class correlation variability).

Conclusion

Subclinical articular PDUS abnormalities are frequently present in IBD patients, independently of activity, evolution time and clinical subtype. Their predictive role on the development of clinical musculoskeletal disease should be investigated in prospective longitudinal studies.