Peripheral Joint and Enthesis Involvement in Patients With Newly Diagnosed Inflammatory Bowel Disease: Symptoms, and Clinical and Ultrasound Findings – A Population-Based Cohort Study

Abstract Objectives Musculoskeletal MSK manifestations in patients with inflammatory bowel disease IBD are common and associated with poorer outcomes. Hence, early detection is important to optimally tailor treatment. We aimed to determine the prevalence and distribution of inflammatory lesions in peripheral joints and entheses in newly diagnosed IBD patients. Design Patients with newly diagnosed IBD from a prospective population-based inception cohort were consecutively included. Data on MSK symptoms were collected by questionnaires and by structured rheumatological interview. Peripheral joints and entheses were assessed clinically and by ultrasound US, using standardized definitions. Results Of 110 included patients (mean age: 42 years, 40% male, 70 with ulcerative colitis UC, 40 with Crohn’s disease CD), a history of ≥1 peripheral musculoskeletal symptom was reported by 49%. Clinical examination revealed peripheral MSK manifestations in 56 52.3% patients; 29 27.1% had ≥1 tender and/or swollen joints and 49 45.8% ≥1 tender entheses. Small peripheral joints were predominantly affected. US found inflammation in ≥1 joint or enthesis in 52 49.5 % patients; 29 27.4 % had US synovitis in ≥1 joint, while 36 34% had US enthesitis. Fibromyalgia classification criteria were fulfilled in seven 7.9% patients. There was no difference in clinical or US findings between patients with UC and CD, nor between patients with active and inactive IBD. Conclusion Half of the patients with newly diagnosed IBD had inflammation in their peripheral joints and/or entheses, documented by rheumatological clinical and US evaluations. This indicates a need for multidisciplinary collaboration to ensure an optimal therapeutic strategy for suppressing inflammation in all disease domains.