Relationship between articular and nonarticular manifestations in inflammatory bowel diseases

Abstract

Background: Musculoskeletal manifestations (MSM) of inflammatory bowel diseases (IBDs) are usually the most frequent extraintestinal manifestations. However, they are not paid enough attention during regular office visits. This cross-sectional study aimed to draw a clinical picture of MSM and their relationships with other findings in patients with IBD. Materials and Methods: Patients of our IBD cohort between March 2012 and September 2013 were consecutively evaluated. Those with current or past history of any MSM were examined by a rheumatologist. The outcome of interest was different MSMs. Distribution of IBD manifestations between the two groups of patients with (n = 20) and without (n = 253) MSM was compared. Logistic regression analysis was employed to find the relationships of demographic, clinical, and laboratory findings with MSM. Results: Two hundred and seventy-three patients were enrolled. Forty-two patients (15.4) had extraintestinal manifestations of which twenty patients (7.5) had at least one MSM. 7/20 patients (35) versus 22/253 (8.7) had other extraintestinal manifestations (P = 0.0001). 12/20 patients (57) had arthritis (polyarthritis, 33 and oligoarthritis, 67). The most frequent involved joints were knee and ankle observed in 8 (40) and 7 (35) patients, respectively. The inflammatory back pain was recorded in 5/20 patients (25) whereas two patients (10) had ankylosing spondylitis. In regression analysis, oral aphthous (odds ratio OR = 8.8 95% confidence intervals (CI), 1.7-45, P = 0.009) and other extraintestinal manifestations (OR = 5.2 95% CI, 1.3-20, P = 0.02) were significantly related with arthritis. Conclusion: The most frequent extraintestinal manifestations in patients with IBD were MSM. Knee and ankle were the most frequent involved joints. Extraintestinal manifestations were determinant variables of arthritis.