Low Back Pain and Sacroiliitis on Cross-Sectional Abdominal Imaging for Axial Spondyloarthritis Diagnosis in Inflammatory Bowel Diseases

Marine Fauny; Nicolas Cohen; Caroline Morizot; Sophie Leclerc-Jacob; Daniel Wendling; Guillaume Lux; Valérie Laurent; Alain Blum; Patrick Netter; Cédric Baumann; Isabelle Chary-Valckenaere; Laurent Peyrin-Biroulet; Damien Loeuille

doi:10.1159/000507930

Low Back Pain and Sacroiliitis on Cross-Sectional Abdominal Imaging for Axial Spondyloarthritis Diagnosis in Inflammatory Bowel Diseases

Inflamm Intest Dis. 2020 Aug;5(3):124-131. doi: 10.1159/000507930. Epub 2020 Jun 3.

Authors

Affiliations

¹ Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France.
² Department of Rheumatology, University Hospital of Besancon, Besancon, France.
³ Department of Radiology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France.
⁴ Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France.
⁵ Unity of Methodology, Data Management and Statistic, University Hospital of Nancy, Nancy, France.
⁶ Department of Gastroenterology and Hepatology, Inserm NGERE, University Hospital of Nancy, Lorraine University, Nancy, France.
⁷ Inserm U1256 NGERE, Lorraine University, Vandoeuvre-Les-Nancy, France.

Abstract

Background: Joint damage is the most frequent extraintestinal manifestation in inflammatory bowel disease (IBD).

Aims: The aim of the study was to assess the value of low back pain (LBP) associated with sacroiliitis on abdominal imaging for the diagnosis of spondyloarthritis (SpA) in IBD.

Methods: We used a questionnaire assessing rheumatological symptoms for all patients with abdominal computed tomography (CT) and magnetic resonance enterography (MRE). Sacroiliitis was assessed on available CT and MRE. Patients were classified as axial SpA according to the Assessment of SpondyloArthritis International Society criteria.

Results: Fifty-one patients completed the questionnaire and performed both exams. LBP was present in 27 patients (52.9%), and 10 (19.6%) had an inflammatory component. Sacroiliitis was reported in 12 patients (23.5%), and 6 of them suffered from LBP. Among the 20 patients referred to the rheumatologist, 11 patients suffered from LBP. One patient was HLA-B27 positive and presented sacroiliitis. For the last 10 patients, none of them had a sacroiliitis, and 2 patients were negative for HLA-B27.

Conclusion: An axial SpA has been diagnosed in 11.8% of IBD patients undergoing cross-sectional imaging, whereas one-fifth had inflammatory LBP, and sacroiliitis was observed in one-quarter of them. To optimize the diagnosis of axial SpA, HLA-B27 testing might be required for patients with both IBD and LBP, but this will require further investigation before its implementation in routine practice.

Keywords: Imagery; Inflammatory bowel disease; Sacroiliitis; Spondyloarthritis.