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P185 Multidisciplinary approach in IBD patients with arthralgias: Usefulness of a combined reumatologic and gastroenterologic assessment in a prospective study

M. Ascolani*1, M.S. Chimenti2, S. Onali1, P. Conigliaro2, E. Ballanti3, G. Collalti2, E. Calabrese1, E. Lolli1, A. Ruffa1, C. Petruzziello1, F. Pallone1, R. Perricone4, L. Biancone1

1Università di Roma Tor Vergata, Medicina dei sistemi, cattedra di Gastroenterologia, Roma, Italy, 2Università degli Studi di Roma "Tor Vergata", Medicina dei Sistemi, Rome, Italy, 3Università degli Studi di Roma "Tor Vergata", Medicina dei Sistemi, Roma, Italy, 4Università degli Studi di Roma "Tor Vergata", Reumatologia, Rome, Italy

Background

The real prevalence of rheumatologic abnormalities in patients with Inflammatory Bowel Disease (IBD) may be underestimated by gastroenterologists. In a prospective study, we evaluated the prevalence and characteristics of articular manifestations in IBD patients, as assessed by a dedicated rheumatologist. Therapeutic changes after the combined assessment were evaluated.

Methods

From December 2012 to November 2013, all IBD patients referring articular pain to the IBD-dedicated gastroenterologist were referred to an experienced rheumatologist. Assessment was made according to current guidelines. Statistical analysis: Data were recorded in a common database expressed as median (range), Student's T test, chi-square test.

Results

During the 12 months follow up, 1275 IBD outpatients were assessed. Arthralgias occurred in 93/1275 (7.3%) IBD patients referred to the rheumatologist. Ulcerative Colitis (UC) group included 38 patients (11 M): age 46 years (18-77), UC duration 10 years (0-47), all inactive (Mayo score<3), pancolitis in 18 (47%), left-sided in 15 (40%), distal in 5 (13%), active smokers (n=8; 21%), ex- smokers (n=11;29%), family history of IBD in 4 (11%).Crohn's Disease(CD) group included 55 patients: 18 M; age 49 years (20-89),CD duration 17 years (range 1-40), active CD in 49 (89%), mildly active 6 (11%), 19 smokers (35%), family history of IBD in 5 (9%). Montreal classification: B1 in 31 (56%), B2 in 22 (40%), B3 in 2 (4%), P in 5 (9%); L1 in 24 (44%), L2 in 8 (14%), L3 in 23 (42%), L4 in 2 (4%). Among the 93 IBD patients with arthralgias, rheumatologists diagnosed rheumatologic diseases in 33 (88%) UC and in 44 (80%) CD, including: enteropathic-related Spondyloarthritis (SpAe) in 50 (54%) IBD (54% peripheral SpA, 24%, axial SpA, 22% both), osteoarthritis in 24 (26%), fybromialgia in 6 (7%), gout in 3 (3%), rheumatoid arthritis in 3 (3%), psoriatic arthritis in 2 (2%). Diagnosis was inconclusive in 5 (6%) patients. After rheumatological assessment, a higher percentage of IBD patients 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 IBD-dedicated gastroenterologists and rheumatologists allows a proper diagnosis, management and treatments of arthralgias in IBD.