title: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Alimohammad
authors.initials: A
authors.lastname: Fatemi
authors.affiliation: Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Hourossadat Hashemi
authors.initials: HH
authors.lastname: Jazi
authors.affiliation: Department of Gastroenterology, Poursina Hakim Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammad Hasan
authors.initials: MH
authors.lastname: Emami
authors.affiliation: Department of Gastroenterology, Poursina Hakim Research Institute, Islamic Azad University of Najafabad, Najafabad, Isfahan, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Kazemizadeh
authors.affiliation: Department of Gastroenterology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Tavakkoli
authors.affiliation: Department of Epidemiology, Indiana University School of Public Health, Bloomington, IN, USA.
authors.forename: Abbas
authors.initials: A
authors.lastname: Smiley
keywords: Arthritis; Crohn's disease; musculoskeletal manifestations; ulcerative colitis