AB0872 Influence of joint and enthesis damage on the quality of life of patients with inflammatory bowel diseases.

Abstract

BackgroundInflammatory bowel diseases (IBD) are chronic immune-inflammatory diseases that are often associated with various extraintestinal manifestations [1]. Among them, joint involvement is the most common, occurring in 5–20% of patients with IBD [1], while the prevalence of enthesitis varies in studies from 12.5% to 90% of cases [2].ObjectivesTo assess the relationship between the state of peripheral joints and entheses in patients with IBD and their quality of life.Methods95 pts with IBD were prospectively enrolled into the study: 55 of them with ulcerative colitis (UC) and 40 with Crohn’s disease (CD). The average age of the pts was 32 (26; 37) years. The average duration of the disease was 44 (12; 95) months. The severity of UC exacerbation was assessed by the Mayo index, in CD – by Harvey-Bradshaw index. In UC, moderate and severe exacerbation was revealed in 40 pts (73%), in CD - in 17 (43%). Among 95 pts with IBD, extraintestinal manifestations occurred in 67 pts (71%), of which 34 (62%) pts with UC and 33 (82%) pts with CD. 14 joints and 68 enthesis were evaluated clinically and by US in each pt. The clinical examination included tenderness of enthesis. US examination with power Doppler detected synovitis with / without vascularization, inflammatory (hypoechogenicity of enthesis, thickening of enthesis, presence of vascularization) and structural (erosion, enthesophyte) changes in enthesis. The quality of life was assessed using the SF-36 questionnaire that covers eight health domains. Scores for each domain range from 0 to 100, with a higher score defining a more favorable health state. Spearman coefficient used to calculate correlations.Results61 pts with IBD (64%) complained of pain in the joints, 49 pts (52%) noted pain on palpation of entheses. As a result of ultrasound examination, synovitis were detected in 41 pts (43%), including synovitis with vascularization in 29 pts (31%). Enthesitis were found in 72 pts (76%), while vascularized enthesitis was detected in 35 pts (37%). Erosions were identified in 76 pts (80%), and enthesophytes were identified in 37 pts (39%). The average level of physical health was 43.53 (35.67; 51.66), mental health 38.53 (31.13; 48.37).An inverse correlation was observed between the number of extraintestinal manifestations and physical functioning (SR=-0.22; p=0.03). The number of painful joints was inversely correlated with physical functioning (SR= -0.22; p=0.03), pain intensity (SR= -0.23; p=0.02), vital activity (SR= -0.23; p=0.027), as well as with physical health (SR= -0.21; p=0.04). The number of painful entheses was inversely correlated with physical functioning (SR = -0.21; p = 0.03), pain intensity (SR = -0.3; p = 0.003) and physical health (SR = -0, 21; p=0.03). An inverse correlation was observed between the number of synovitis with vascularization and physical functioning (SR= -0.26; p=0.01), vital activity (SR= -0.29; p=0.005), physical health (SR=-0.23; p=0.024). The number of enthesitis was inversely correlated with the pain intensity (SR = -0.22; p = 0.036).ConclusionWith an increase in the number of affected joints and enthesis, the physical health of pts decreases, due to physical functioning and pain intensity, as well as their vital activity.References[1]The First European Evidence-based Consensus on Extra-Intestinal Manifestations in IBD. JCC. 2016; 10 (3): 239-254. doi: 10.1093/ecco-jcc/jjv213[2]Cantini F., Niccoli L., Nannini C. et al. Case-control Study on Dactylitis, Enthesitis, and Anterior Uveitis in Spondyloarthritis Associated with Inflammatory Bowel Diseases: Role of Coexistent Psoriasis. J. Rheumatol. 2017; 44: 1341–6. doi:10.3899/jrheum.161518Disclosure of InterestsNone declared