Abstract
This is a cross-sectional study that analyzed the pattern and frequency of articular and ophthalmologic manifestations in patients with Crohn’s disease (CD) and ulcerative colitis (UC), with or without signs of active bowel inflammation. One hundred and thirty consecutive patients with CD (n = 71) and UC (n = 59) were examined. Simple X-rays of lumbar spine, sacroiliac joints, and calcaneal bone were performed and human leukocyte antigen (HLA)-B27 was typed. Joint manifestations occurred in 41 (31.5%) patients, 27 (38%) with CD and 14 (23.7%) with UC. Peripheral involvement occurred in 22 patients, axial involvement in five, and mixed involvement in 14. The most frequently involved joints were knees (56.1%), ankles (29.3%), and hips (29.3%), while the predominant pattern was oligoarticular (84.6%) and asymmetrical (65.6%). Enthesitis was identified in seven (5.4%) patients and inflammatory lumbar pain in 13 (10%). Eight of these patients fulfilled the diagnostic criteria for ankylosing spondylitis (6.2%). Radiographic sacroiliitis occurred in 12 patients (9.2%). Ocular abnormalities were present in six patients (6.2%), and HLA-B27 was positive in five (5.8%). In conclusion, the articular manifestations in the present study were predominantly oligoarticular and asymmetric, with a low frequency of ophthalmologic involvement and positive HLA-B27.
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Palm O, Moum B, Ongre A, Gran JT (2001) The prevalence and incidence of peripheral arthritis in patients of inflammatory bowel disease, a prospective population-based study (the IBSEN Study). Rheumatology 40(11):1256–1261
Souza MHLP, Troncon LEA, Rodríguez CM et al (2002) Evolução da ocorrência (1980–1999) da doença de Crohn e da retocolite ulcerativa idiopática e análise de suas características clínicas em um Hospital Universitário do sudeste do Brasil. Arq Bras Gastroenterol 339(2):98–105
Turkcapar N, Toruner M, Soykan I et al (2006) The prevalence of extraintestinal manifestations and HLA association in patients with inflammatory bowel disease. Rheumatol Int 26(7):663–668
Mendoza JL, Lana R, Taxonera C et al (2005) Extraintestinal manifestations in inflammatory bowel disease: differences between Crohn’s disease and ulcerative colitis. Med Clin (Barc) 25(8):297–300
Bargen JA (1930) Complications and sequelae of chronic ulcerative colitis. Ann Intern Med 3:335–352
Bywaters EGL, Ansell BM (1958) Arthritis associated with ulcerative colitis: a clinical and pathologic study. Ann Rheum Dis 17:169–183
Moll JMH, Haslock I, Macrae IF, Wright V (1974) Association between ankylosing spondylitis, psoriatic arthritis, Reiter’s disease, the intestinal arthropathies, and Behçet’s syndrome. Medicine 53(5):343–463
Dougados M, Van der Linden SR et al (1991) The European Spondyloarthropathy Study Group: the European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathy. Arthritis Rheum 34:1218–1227
Braun J, Bollow M, Remlinger G et al (1998) Prevalence of spondyloarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41(1):58–67
Orchard TR, Wordsworth BP, Jewell DP (1998) Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut 42(3):387–391
Smale S, Natt RS, Orchard TR, Russell AS, Bjarnason I (2001) Inflammatory bowel disease and spondyloarthropathy. Arthritis Rheum 44:2728–2736
Veloso FT, Carvalho J, Magro F (1996) Immune-related systemic manifestations of inflammatory bowel disease. A prospective study of 792 patients. J Clin Gastroenterol 23(1):29–34
Holden W, Orchard T, Wordsworth P (2003) Enteropathic arthritis. Rheum Dis Clin North Am 29:513–530
Haslock I, Wright V (1973) The musculo-esqueletal complications of Crohn’s disease. Medicine 52(3):217–225
Dekker-Saeys BJ, Meuwiessen SGM, Van der Bergen-Loonen EM et al (1978) Prevalence of peripheral arthritis, sacroiliitis and ankylosing spondylitis in patients suffering from inflammatory bowel disease. Ann Rheum Dis 37:33–35
Münch H, Purrmann J, Reis HE et al (1986) Clinical features of inflammatory joint and spine manifestations in Crohn’s disease. Hepatogastroenterology 33:123–127
Danzi JT (1988) Extraintestinal manifestations of idiopathic inflammatory bowel disease. Arch Intern Med 148:297–302
Scarpa R, Del Puente A, D’Arienzo A et al (1992) The arthritis of ulcerative colitis: clinical and genetics aspects. J Rheumatol 19(3):373–376
Maeda K, Okada M, Yao T et al (1994) Intestinal and extraintestinal complications of Crohn’s disease: predictors and cumulative probability of complications. J Gastroenterol 29:577–582
Mielants H, De Vos M, Cuvelier C, Veys EM (1996) The role of gut inflammation in the pathogenesis of spondyloarthropathies. Acta Clin Belg 51(5):340–349
Triantafillidis JK, Emmanouilidis A, Manousos O et al (2000) Clinical patterns of Crohn’s disease in Greece: a follow-up study of 155 cases. Digestion 61:121–128
Salvarani C, Vlachonikolis IG, Van der Heidje DM et al (2001) Musculoskeletal manifestations in a population-based cohort of inflammatory bowel disease patients. Scand J Gastroenterol 12:1307–1313
De Vlam K, Mielants H, Cuvelier C et al (2000) Spondyloarthropathy is underestimated in inflammatory bowel disease: prevalence and HLA association. J Rheumatol 27(12):2860–2865
Palm O, Moum B, Ongre A, Gran JT (2002) Prevalence of ankylosing spondylitis and other spondyloarthropathies among patients with inflammatory bowel disease: a population study (the IBSEN Study). J Rheumatol 29(3):511–515
Christodoulou DK, Katsanos KH, Kitsanou M et al (2002) Frequency of extraintestinal manifestations in patients with inflammatory bowel disease in northwest Greece and review of the literature. Dig Liver Dis 34(11):781–786
Goldfarb M, Leite N, Rubistein J et al (1985) Manifestações reumáticas na retocolite ulcerativa idiopática. Estudo de 98 casos no HSE e revisão da literatura. Rev Bras Reumatol 25(2):53–56
Sands BE (2002) Crohn’s disease. In: Feldman M, Friedman LS, Sleisenger MH (eds) Gastrointestinal and liver disease pathophysiology diagnosis/management. 7th edn. Saunders, Philadelphia, pp 2005–2038
Jewell DP (2002) Ulcerative colitis. In: Feldman M, Friedman LS, Sleisenger MH (eds) Gastrointestinal and liver disease pathophysiology diagnosis/management. 7th edn. Saunders, Philadelphia, pp 2039–2067
Gasche C, Scholmerich J, Brynskov J et al (2000) A simple classification of Crohn’s disease: report of the working party of the World Congress of Gastroenterology, Vienna 1998. Inflamm Bowel Dis 6(1):8–15
Farmer RG (1987) Nonspecific ulcerative proctitis. Gastroenterol Clin North Am 16:154–174
Calin A, Porta J, Fries JF, Schurman DJ (1977) Clinical history as a screening test for ankylosing spondylitis. JAMA 237(24):2613–2614
Van der Linden S (2001) Ankylosing spondylitis. In: Kelley WN, Harris ED, Rudy S, Sledge CB (eds) Textbook of rheumatology. 5th edn. Saunders, Philadelphia, pp 1039–1069
Van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum 27:361–368
Bernstein CN, Blanchard JF, Rawsthorne P, Yu N (2001) the prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol 96(4):1116–1121
Mielants H, Veys EM, Cuvelier C et al (1995) The evolution of spondyloarthropathies in relation to gut histology: III relation between gut and joint. J Rheumatol 22(12):2279–2284
De Keyser F, Elewaut D, De Vos M et al (1998) Bowel inflammation and spondyloarthropathies. Rheum Dis Clin North Am 24(4):785–812
Edmunds L, Elswood J, Kennedy LG, Calin A (1991) Primary ankylosing spondylitis, psoriatic and entheropathic spondyloarthropathy: a controlled analysis. J Rheumatol 18(5):696–698
Dekker-Saeys BJ, Meuwiessen SGM, Van der Bergen-Loonen EM et al (1978) Clinical characteristics and results of histocompatibility typing (HLA B27) in 50 patients with both ankylosing spondylitis and inflammatory bowel disease. Ann Rheum Dis 37:36–41
Ferreira E, Ward FE, Amos DB (1975) HL-A in a Brazilian population: evidence for new HL-A specificities. In: Kissmeyer-Nielsen G (ed) Histocompatibility testing. Munksgaard, Copenhagen
Moraes HV Jr (1996) Uveíte anterior aguda e HLA-B27: valor diagnóstico e prognóstico. Rev Bras Oftalmol 55:53–62
Salmon JF, Wright JP, Murray AD (1991) Ocular inflammation in Crohn’s disease. Ophthalmology 98:480–484
Lyons JL, Rosenbaun JT (1997) Uveitis associated with inflammatory bowel disease compared with uveitis associated with spondyloarthropathy. Arch Ophthalmol 115(1):61–64
Pato E, Bañares A, Jover JÁ et al (2000) Undiagnosed spondyloarthropathy in patients presenting with anterior uveitis. J Rheumatol 27(9):2198–2202
Rosenbaun JT (1989) Characterization of uveitis associated with spondyloarthritis. J Rheumatol 16(6):792–796
Linssen A, Meenken C (1995) Outcomes of HLA B27-positive and HLA B27-negative acute anterior uveitis. Am J Ophthalmol 120:351–361
Carvalho MAP, Campos WR, Araujo CAA et al (1999) Uveítes anteriores não granulomatosas, espondiloartropatias e HLA B27. Rev Bras Reumatol 39(4):195–202
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The authors wish to thank Dr. Percival Degrava Sampaio-Barros for his aid in the preparation of this manuscript.
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Lanna, C.C.D., Ferrari, M.d.L.A., Rocha, S.L. et al. A cross-sectional study of 130 Brazilian patients with Crohn’s disease and ulcerative colitis: analysis of articular and ophthalmologic manifestations. Clin Rheumatol 27, 503–509 (2008). https://doi.org/10.1007/s10067-007-0797-5
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DOI: https://doi.org/10.1007/s10067-007-0797-5