L. Brakenhoff

IBD and arthropathies: a practical approach to its diagnosis and management

Arthropathies are a major clinical problem in patients with inflammatory bowel disease (IBD). Often it is difficult to control the articular symptoms with the anti-inflammatory strategies used for IBD. Studies evaluating specific treatments aimed at articular manifestations in patients with IBD are rare. Although there has been considerable interest in the gut–joint axis over the last decade, the pathophysiological mechanisms driving IBD-associated arthropathy are still unknown. Recently, interest in the multidisciplinary approach to patients with IBD and arthropathy has been increasing. New research and clinical projects aimed at understanding the mechanisms of disease may advance the development of effective therapies. In this review, the pathophysiology of IBD-associated arthropathy is discussed, as well as clinical manifestations, the classification and current therapeutic strategies.

Classifying Back Pain and Peripheral Joint Complaints in Inflammatory Bowel Disease Patients: A Prospective Longitudinal Follow-up Study

BACKGROUND AND AIMS Peripheral joint complaints [pJTC] and chronic back pain [CBP] are the most common extra-intestinal manifestations in patients with inflammatory bowel disease [IBD]. This prospective study evaluates variables associated with joint/back pain, including IBD disease activity. METHODS IBD patients with back pain ≥ 3 months and/or peripheral joint pain/swelling [n = 155], and IBD patients without joint complaints [n = 100; controls], were followed for a period of 1 year. Patients were classified as having SpondyloArthritis [SpA] according to several sets of criteria. Statistical analysis included logistic regression models and linear mixed model analysis. RESULTS Of the 155 patients with joint/back pain, 13 had chronic back pain, 80 peripheral joint complaints, and 62 axial and peripheral joint complaints. Smoking, female gender, and IBD disease activity were independently associated with IBD joint/back pain. The Assessment in Spondyloarthritis International Society criteria for axial and peripheral SpA were fulfilled in 12.3% of patients, with 9.7% [n = 15] receiving a rheumatological diagnosis of arthritis. During the 12-month follow-up, the majority of the patients reporting joint/back pain remained stable. CONCLUSIONS In our cohort, the majority of IBD patients reported joint/back pain and SpA was relatively common. To facilitate effective care, gastroenterologists should be aware of the various features of SpA to classify joint complaints and, by making use of an efficient referral algorithm, to refer CBP patients to the rheumatologist.

P294 Back pain in inflammatory bowel disease patients

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

THU0413 Magnetic resonance imaging of hands and feet joints of ACPA positive persons without clinical arthritis

Background Until recently, the development of clinical detectable arthritis was considered as the start of Rheumatoid Arthritis (RA). Several studies have revealed that anti-citrullinated peptide antibodies (ACPA) can be present and mature years before arthritis develops and that markers of systemic inflammation and bone degradation are also elevated in the preclinical phase. These data suggest that the process of RA starts earlier than clinical arthritis occurs. It is however unknown whether local subclinical inflammation is present in the preclinical phase. MRI is sensitive in detecting subclinical inflammation. Objectives To investigate whether there is subclinical inflammation in painful joints in ACPA-positive arthralgia patients without clinical arthritis. Methods Painful hand or feet joints of 15 ACPA positive patients without clinical arthritis were imaged, as well as comparable small joints at a non-painful site. In addition, for further comparisons, small joints of 6 ACPA positive RA patients and 8 persons with inflammatory bowel disease but without arthralgia were evaluated. Imaging was performed on a MSK Extreme 1.5T extremity MRI (GE, Wisconsin, USA). Acquired sequences were coronal T1, coronal T2 fat sat and coronal and axial T1 fat sat after IV Gadolinium-chelate administration. Scoring was performed by two trained readers according to the OMERACT RAMRIS scoring method. The mean scores of the two readers were analyzed. Analyses were performed on joint level (MCP, PIP, wrist or MTP joints). Results The mean total RAMRIS score of the MCP/PIP joints in the persons without arthralgia, the painful joints of ACPA-positive arthralgia patients and painful joints of ACPA-positive RA patients were 0.1, 0.8 and 3.7 respectively (Kruskal-Wallis test, p=0.004). The scores of the painful joints and painless joints in ACPA-positive arthralgia patients were strongly correlated (rs=0.75) and not different between the groups (mean 1.9 and 2.4, respectively). The mean total RAMRIS scores of the wrist and MTP joints in ACPA-positive arthralgia were 4.2 and 2.1, which was lower than those of RA patients (7.8 and 2.8 respectively). Unfortunately the wrist and MTP joints of the controls were not imaged. Conclusions The present data suggest that, when compared to both controls and ACPA-positive RA, patients with arthralgia with ACPA but no clinical arthritis have subclinical inflammation locally at the site of the pain. Furthermore, the non-painful small joints show abnormalities that are comparable in severity to that of the painful joints. Disclosure of Interest None Declared