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P113 Subclinical Ultrasonographic Enthesopathy and Synovitis in patients with Inflammatory Bowel Disease (IBD) without clinical signs or symptoms of Spondyloarthritis

E. Vicente*1, 2, S. Pérez2, L. Merino1, I. Llorente1, M. Chaparro3, F. Rodríguez-Salvanés4, L. Vega4, S. Castañeda1, J.P. Gisbert3

1Hospital Universitario de La Princesa, IIS-IP, Rheumatology Unit, Madrid, Spain, 2Fundación Jiménez Díaz, Madrid, Spain, 3Hospital Universitario de La Princesa, IIS-IP and CIBERehd, Gastroenterology Unit, Madrid, Spain, 4Hospital Universitario de La Princesa, IIS-IP, Epidemiologic Research Unit, Madrid, Spain

Background

Musculoskeletal manifestations, as peripheral arthritis, axial disease and enthesitis, are present in 10-60% of IBD patients. As ultrasonography is more sensitive than physical examination to detect enthesopathy and synovitis, it may be useful to identify subclinical involvement.

Objectives: To evaluate the presence of subclinical enthesitis and synovitis with power Doppler ultrasonography (PDUS) in IBD patients and to investigate its correlation with clinical variables.

Methods

IBD patients without clinically overt musculoskeletal disease were prospectively recruited. Gastroenterological, rheumatological and PDUS evaluation, blind to each other, were performed. Clinical assessment included demographics, comorbidities, IBD characteristics, joint load and musculoskeletal clinical examination. PDUS evaluation consisted of the detection of grey scale (GS) and power Doppler (PD) signs of enthesopathy and synovitis in 12 enthesis scored according to the Madrid Ankylosing Spondylitis Enthesitis Index (MASEI) and in 44 joints using a LOGIQ7 General Electric machine with a 12-MHz linear array transducer.

Results

35 (51% male) IBD patients [17 Crohn's disease (CD) and 18 ulcerative colitis (UC)], have been included so far. Clinical variables (mean±SD): Age 42 ± 12 years, CDAI 20 ± 17, Mayo index 0.4 ± 0.9, DMARD therapy in 98.6% for 5.5 ± 5 years, ESR 12 ± 8 mm/h and CRP 0.13 ± 0.19 mg/dL. A positive MASEI was present in 98.6%, with a mean score of 33 ± 9. GS enthesal abnormalities were found in at least 1 enthesis in 100% of patients: enthesophytes or calcifications (100%), altered echoestructure (100%), increased thickness (100%), erosion (17%) and bursitis (34%). The most severely affected enthesis were Achilles tendon and plantar fascia. GS joint effusion and synovial hypertrophy (SH) in at least 1 joint were present in 86% and 94%, respectively, with poliarticular ( ≥ 5 joints) involvement in 40% and 60%, respectively. Entheseal and joint PD signal was positive in 43% and 40% of patients, respectively. Joint effusion and synovial hypertrophy were more frequent in MTF, MCF, carpal and knee joints and PD signal in carpal and knee joints. SH scores were significantly higher in UC than in CD (p=0.003). SH and PD scores were associated with age (p<0.05). The intra-reader agreement was high (0.8 intra-class correlation variability).

Conclusion

Subclinical joint and entheseal PDUS abnormalities are common in IBD patients, regardless of clinical subtype, evolution time and intestinal activity. SH seems more severe in UC than in CD. Prospective longitudinal studies are needed to define its predictive value of clinically overt musculoskeletal disease and its association with structural deterioration