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Clinical and genetic factors associated with sacroiliitis in Crohn's disease
Harald Peeters1, Bert Vander Cruyssen, Herman Mielants
1Department of Gastroenterology, Ghent University Hospital, Gent, Belgium. harald.peeters@ugent.be
Insights
Radiographic sacroiliitis (SI) is common in Crohn's disease (CD) patients. SI is linked to peripheral arthritis but not CARD15 polymorphisms, suggesting shared pathways for these extra-intestinal manifestations.
Area of Science:
- Gastroenterology and Rheumatology
- Inflammatory Bowel Disease Research
- Clinical Manifestations of Crohn's Disease
Background:
- Radiographic sacroiliitis (SI) is the most frequent extra-intestinal manifestation (EIM) in Crohn's disease (CD).
- Limited data exist on SI's association with other CD clinical features and CARD15 polymorphisms.
- This study investigates SI associations in a multicenter CD cohort.
Purpose of the Study:
- To determine the prevalence of radiographic sacroiliitis in Crohn's disease patients.
- To investigate the association of sacroiliitis with clinical phenotypes, other EIMs, and CARD15 polymorphisms.
- To clarify the relationship between SI, ankylosing spondylitis, and peripheral arthritis in CD.
Main Methods:
- Radiographs of sacroiliac joints were assessed in 251 CD patients.
- Clinical data and CARD15 polymorphism status were collected from medical records.
- Statistical analyses (univariate and multivariate) were performed to identify associations.
Main Results:
- Radiographic sacroiliitis was diagnosed in 27% of CD patients.
- SI was significantly associated with peripheral arthritis (P = 0.005).
- No association was found between SI and CARD15 polymorphisms or other clinical features.
Conclusions:
- Radiographic sacroiliitis is highly prevalent in CD.
- SI is associated with peripheral arthritis, suggesting shared pathogenesis.
- The previously suggested link between SI and CARD15 polymorphisms was not confirmed in this cohort.
Background And Aim:
Radiographic sacroiliitis (SI), often asymptomatic, is considered the most frequent extra-intestinal manifestation (EIM) of Crohn's disease (CD). Data on the association of SI with other clinical features of CD are limited. Association of SI with CARD15 polymorphisms has recently been suggested. In a multicenter study, we investigated the association of SI in CD patients with clinical phenotypes, other EIM and CARD15 polymorphisms.
Methods:
Radiographs of the sacroiliac joints were taken in 251 CD patients from three Belgian university hospitals and scored by two blinded rheumatologists. Clinical features were obtained from medical records. Forty-three percent of patients carried at least one CARD15 polymorphism.
Results:
Sacroiliitis, defined as the presence of at least grade 2 unilateral changes, was diagnosed in 65 of the 244 scorable radiographs (27%). Only 16 of these patients were previously diagnosed with ankylosing spondylitis (AS). HLA-B27 positivity was observed in 53% of patients with AS and 7% of patients with radiographic SI. In univariate and multivariate analysis, associations between the presence of SI and peripheral arthritis (P = 0.005) and between AS and uveitis (P = 0.005) were found. No associations with other recorded clinical features or with CARD15 polymorphisms were observed.
Conclusion:
We confirm the high prevalence of radiographic sacroiliitis in a multicenter CD cohort. Uveitis is only associated with AS whereas all patients with SI are more prone to develop peripheral arthritis during their disease course, suggesting similar pathogenetic mechanisms in the development of these EIM. The previously reported association between SI and CARD15 polymorphisms was not confirmed.
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