title: Ultrasound discloses entheseal involvement in inactive and low active inflammatory bowel disease without clinical signs and symptoms of spondyloarthropathy.
abstract: OBJECTIVE
  To investigate the presence of lower limb entheseal abnormalities in IBD patients without clinical signs and symptoms of SpA and their correlation with IBD clinical variables.
  
  
  METHODS
  A total of 81 IBD patients [55 Crohn's disease (CD) and 26 ulcerative colitis (UC), 43 females and 38 males, mean age 41.3 (12.4) years, BMI 24 (2)] with low active (12) and inactive (67) disease were consecutively studied with US (LOGIQ5 General Electric 10-MHz linear array transducer) of lower limb entheses and compared with 40 healthy controls matched for sex, age and BMI. Quadriceps, patellar, Achilleon and plantar fascia entheses were scored according to the 0-36 Glasgow Ultrasound Enthesitis Scoring System (GUESS) and power Doppler (PD). Correlations of GUESS and PD with IBD features [duration, type (CD/UC) and activity (disease activity index for CD/Truelove score for UC)] were investigated. The intra- and inter-reader agreements for US were estimated in all images detected in patients and controls.
  
  
  RESULTS
  Of the 81 patients, 71 (92.6%) presented almost one tendon alteration with mean GUESS 5.1 (3.5): 81.5% thickness (higher than controls P < 0.05), 67.9% enthesophytosis, 27.1% bursitis and 16.1% erosions. PD was positive in 13/81 (16%) patients. In controls, US showed only enthesophytes (5%) and no PD. GUESS and PD were independent of duration, activity or type (CD/UC) of IBD. The intra- and inter-reader agreements were high (>0.9 intra-class correlation variability).
  
  
  CONCLUSIONS
  US entheseal abnormalities are present in IBD patients without clinical signs and symptoms of SpA. US enthesopathy is independent of activity, duration and type of gut disease.
authors.affiliation: Department of Biomedicine, Division of Rheumatology, University of Florence, Florence, Italy. bandin@hotmail.it
authors.forename: Francesca
authors.initials: F
authors.lastname: Bandinelli
authors.forename: Monica
authors.initials: M
authors.lastname: Milla
authors.forename: Stefania
authors.initials: S
authors.lastname: Genise
authors.forename: Leonardo
authors.initials: L
authors.lastname: Giovannini
authors.forename: Siro
authors.initials: S
authors.lastname: Bagnoli
authors.forename: Antonio
authors.initials: A
authors.lastname: Candelieri
authors.forename: Ledio
authors.initials: L
authors.lastname: Collaku
authors.forename: Silvia
authors.initials: S
authors.lastname: Biagini
authors.forename: Marco Matucci
authors.initials: MM
authors.lastname: Cerinic
mesh_terms: D000328:Adult; D017677:Age Distribution; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011379:Prognosis; D012016:Reference Values; D012216:Rheumatic Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D025242:Spondylarthropathies / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D014463:Ultrasonography