Peripheral arthritis in the course of inflammatory bowel diseases.
BACKGROUND
Musculoskeletal disorders are well-defined extra-intestinal manifestations of inflammatory bowel diseases (IBD). There is little data regarding the frequencies of IBD and extra-intestinal manifestations from Central and East Europe and Middle Eastern countries.


OBJECTIVE
To determine the prevalence of peripheral arthritis in IBD and to document the relationship to other extra-intestinal manifestations.


METHODS
Enrolled in the study were 357 patients who were diagnosed with IBD from December 2002 through January 2008. All of the patients underwent a detailed whole-body examination by a gastroenterologist and rheumatologist.


RESULTS
IBD-related peripheral arthritis (IBDPA) was found in 66 (18.5%) of the 357 patients (28.3% Crohn's disease, 13.5% ulcerative colitis; p=0.001 χ=11.62). IBDPA was more frequent in female patients (60.6 vs. 39.4%, p=0.000, χ=11.12). In eight (12.1%) cases, IBDPA occurred before the onset of IBD. Acute self-limiting episodes, recurrences of the attacks, and persistent symptoms of arthritis were present in 40 (60.6%), 26 (39.3%), and 29 (45.7%) patients, respectively. Arthritis was symmetrical in 33 (50%) cases. Knees (65.2%) and ankles (62.1%) were the most commonly affected joints. Erythema nodosum and pyoderma gangrenosum were more common among patients with IBDPA than patients without it (p=0.001, χ=10.49, and p=0.000 χ=25.77, respectively).


CONCLUSIONS
IBDPA is a frequent extra-intestinal complication of IBD. Those of female gender and the presence of Crohn's disease, erythema nodosum and pyoderma gangrenosum have a higher risk to develop IBDPA.
Yüksel
Ilhami
I
Department of Gastroenterology, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey. yukselilhami@hotmail.com
Ataseven
Hilmi
H
Başar
Omer
O
Köklü
Seyfettin
S
Ertuğrul
Ibrahim
I
Ulker
Aysel
A
Dağlı
Ulkü
U
Saşmaz
Nurgül
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000843:Ankle Joint; D001168:Arthritis / Q000453:epidemiology*; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications* / Q000453:epidemiology; D003424:Crohn Disease / Q000150:complications* / Q000453:epidemiology; D004893:Erythema Nodosum / Q000150:complications / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D015995:Prevalence; D017511:Pyoderma Gangrenosum / Q000150:complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult
Rheumatology (Oxford). 2001 Nov;40(11):1256-61
11709609
Medicine (Baltimore). 1976 Sep;55(5):401-12
957999
Am J Gastroenterol. 1988 Mar;83(3):216-23
3278591
Br Med J. 1965 Sep 18;2(5463):670-5
14337733
J Clin Gastroenterol. 1996 Jul;23(1):29-34
8835896
Scand J Gastroenterol. 2001 Dec;36(12):1307-13
11761022
Inflamm Bowel Dis. 2009 Apr;15(4):546-50
19023896
Ann Intern Med. 1976 May;84(5):564-6
1275358
Rheumatol Int. 2006 May;26(7):663-8
16136311
Aliment Pharmacol Ther. 1998 May;12(5):397-404
9663718
Gut. 1998 Mar;42(3):387-91
9577346
Gastroenterology. 1979 Oct;77(4 Pt 2):914-20
467943
Clin Exp Rheumatol. 1990 Jan-Feb;8(1):23-7
2347132
Eur J Intern Med. 2000 Aug;11(4):210-214
10967509
Dig Dis. 1992;10(5):274-94
1424228
Medicine (Baltimore). 1973 May;52(3):217-25
20407412
J Clin Gastroenterol. 2009 Jan;43(1):51-7
18724251