Peripheral arthritis in patients with long-term inflammatory bowel disease. Results from 20 years of follow-up in the IBSEN study

Abstract:

Objectives: Peripheral arthritis and related musculoskeletal manifestations, often classified as peripheral spondyloarthritis, are frequently seen in patients with inflammatory bowel disease (IBD). Few long-term studies have reported on the prevalence of these conditions. The aim of this study was to determine the prevalence of IBD-related peripheral arthritis and peripheral spondyloarthritis in IBD patients during 20 years of disease course, and to assess whether these conditions were associated with the intestinal IBD severity and activity.

Materials and methods: In an inception cohort (the IBSEN study), IBD patients were followed prospectively for 20 years. At the 5 year follow-up the patients underwent a rheumatological examination and at the 20 year follow-up they completed a questionnaire with identical questions. When peripheral arthritis was characteristic and not explained by other specific diagnoses, it was defined as IBD-related peripheral arthritis. The Assessment of Spondyloarthritis International Society criteria were used to define peripheral spondyloarthritis, including patients with peripheral arthritis, enthesitis and/or dactylitis.

Results: After 20 years of follow-up, 441 patients were included (296 ulcerative colitis and 145 Crohn’s disease). The prevalence of IBD-related peripheral arthritis was 17.2% and peripheral spondyloarthritis 27.9% during the disease course. IBD severity and activity were not different between those with a history of IBD-related peripheral arthritis or peripheral spondyloarthritis and those without. A higher proportion of women had IBD-related peripheral arthritis and peripheral spondyloarthritis.

Conclusion: During 20 years of disease course, more than every sixth patient had suffered from IBD-related peripheral arthritis and every fourth from peripheral spondyloarthritis.

Keywords:

• Inflammatory bowel disease
• peripheral arthritis
• IBD-related peripheral arthritis
• peripheral spondyloarthritis
• spondyloarthritis
• ulcerative colitis
• Crohn’s disease

Acknowledgements

We thank all of the following members of the Inflammatory Bowel South-Eastern Norway (IBSEN) Study Group for participating in this study: Arne Borthne and Jørgen Jahnsen, Akershus University Hospital; Gert Huppertz-Hauss and Tomm Bernklev, Telemark Hospital Trust; Iril Kempski-Monstad, Randi Opheim, Oslo University Hospital; Pascal Klepp-Larsson, Lovisenberg Hospital; Njaal Stray, Diakonhjemmet Hospital; Magne Henriksen and Lars Petter Jelsness-Jørgensen, Østfold Hospital Trust; Øistein Hovde, Innlandet Hospital Trust; Ole Høie, Sørlandet Hospital; and May-Bente Bengtson, Vestfold Hospital Trust.

Disclosure statement

Marte L. Høivik has received lecture fees from Takeda, MSD, Meda and Abbvie, research grants from Ferring, Tillots and Takeda, and advisory board fees from Takeda. Morten Vatn is a member of the Advisory Board of Genetic Analysis Company.

Additional information

Funding

The IBSEN study has been supported by the South-Eastern Norway Regional Health Authority