title: Hidden musculoskeletal involvement in inflammatory bowel disease: a multicenter ultrasound study.
abstract: BACKGROUND
  Inflammatory bowel diseases are associated with a variety of extra-intestinal manifestations. The most frequent of these is joint involvement, which affects 16-33 % of IBD patients. Our aim was to evaluate the ultrasound prevalence of sub-clinical joint and entheseal involvement in patients with IBD without musculoskeletal symptoms, and to correlate the US findings with clinical and laboratory variables.
  
  
  METHODS
  We recorded the clinical and laboratory data of 76 patients with IBD, 20 patients with spondyloarthritis (SpA) and 45 healthy controls at three rheumatology centers. All of the IBD patients and healthy controls were clinically examined by a rheumatologist in order to confirm the absence of musculoskeletal symptoms, and all of the subjects underwent grey-scale (GS) and power Doppler (PD) US examinations of the second and third metacarpophalangeal joints, knees and lower limbs in order to detect joint or entheseal abnormalities.
  
  
  RESULTS
  A total of 1410 entheseal sites and 1410 joints were evaluated by US. Of the 76 patients with IBD, 64 (84.1 %) had at least one GS entheseal abnormality, and 11 (13.9 %) had more than one PD-positive entheseal site; 32 (42.1 %) showed sub-clinical joint involvement. There was a significant difference between the IBD patients and healthy controls in terms of global entheseal, PD-positive entheseal, and joint involvement (p < 0.0001), but no difference between the IBD and SpA patients. Anti-neutrophil cytoplasmic antibodies predicted entheseal involvement in patients with IBD (OR 6.031; p = 0.015).
  
  
  CONCLUSIONS
  The prevalence of sub-clinical joint and entheseal involvement was higher in IBD patients than healthy controls, but there was no difference between the IBD and SpA patients.
authors.affiliation: Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal. ocisvor@gmail.com.
authors.forename: João
authors.initials: J
authors.lastname: Rovisco
authors.affiliation: Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal.
authors.forename: Cátia
authors.initials: C
authors.lastname: Duarte
authors.affiliation: Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Batticcioto
authors.affiliation: Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Sarzi-Puttini
authors.affiliation: Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Dragresshi
authors.affiliation: Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Portela
authors.affiliation: Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy.|Division of Musculoskeletal and Rheumatic diseases, National Institute of Rehabilitation, Mexico city, Mexico.
authors.forename: Marwin
authors.initials: M
authors.lastname: Gutierrez
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D007592:Joint Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D016037:Single-Blind Method; D014463:Ultrasonography; D055815:Young Adult