Name: Míriam Küster Huber
Type: MSc dissertation
Publication date: 13/05/2019
Advisor:

Name	Role
Maria Bernadete Renoldi de Oliveira Gavi	Advisor *

Examining board:

Name	Role
Adalberta Lima Martins	External Examiner *
Ketty Lysie Libardi Lira Machado	Internal Examiner *
Maria Bernadete Renoldi de Oliveira Gavi	Advisor *

Summary: Introduction: Musculoskeletal symptoms are the most common extraintestinal manifestations in patients with inflammatory bowel disease (IBD). These manifestations are frequent, but few studies have evaluated the prevalence of musculoskeletal manifestations and their correlation with biomarkers like plasma calprotectin and joint and enthesis ultrasonography. Objectives: To determine the prevalence of axial and peripheral Spondyloarthritis (SpA) in a sample of patients with IBD. The specific objectives were: to determine the general prevalence of any joint manifestation; to evaluate the frequency of ultrasonographic synovitis and enthesitis; to evaluate correlation of plasma calprotectin with erythrocyte sedimentation rates, C-reactive protein levels, fecal calprotectin and diagnosis of enteropathic SpA according to ASAS criteria. Methodology: This is an observational cross-sectional study. Patients from the IBD outpatient clinic of a University Hospital in the State of Espírito Santo were interviewed for joint manifestations. Those patients identified with signs and / or symptoms of the spectrum of SpA, such as inflammatory low back pain for more than 3 months and / or arthritis and / or enthesitis and / or dactylitis and / or uveitis were selected for complementary examinations. The variables of interest in the study were erythrocyte sedimentation rates, C-reactive protein levels, ultrasonographic synovitis and enthesitis, fecal and plasma calprotectin, WHEREas HLA B27 and MRI of sacroiliacs were used only for the purpose of SpA classification according to ASAS criteria. All biochemical variables that evaluate inflammation were collected at the same time. MRI of sacroiliacs was evaluated by a single radiologist experienced in imaging of the musculoskeletal system and who did not have access to the clinical picture of the patient. The evaluation by joint and entheseal ultrasonography was performed by two experienced rheumatologists who performed independent and blind evaluations. The p-value lower than 0.05 was considered in the analyzes. Results: 30.5% of the studied sample (N 118) of patients with IBD presented at least one inflammatory musculoskeletal manifestation. The overall prevalence of enteropathic SpA was 13.55%, being 10.16% of axial SpA and 4.23% of peripheral SpA according to the ASAS criteria. 42.1% of the patients with MASEI greater than 18, 35.2% of patients with synovitis and 14.7% with tenosynovitis, increasing the frequency of diagnosis of enteropathic SpA to 22.8%. Plasma calprotectin correlated with fecal calprotectin (p 0.041). 58.3% of the patients who reported some musculoskeletal manifestation never visited a rheumatologist. Conclusions: One third of patients with IBD had some inflammatory musculoskeletal complaints and 13.5% had ASAS criteria for enteropathic SpA. Sintomatic joint and enthesis ultrasound increased the diagnostic sensitivity of peripheral SpA. Plasma calprotectin correlated with fecal calprotectin.
Key Words: inflammatory bowel disease, spondyloarthritis, joint and enthesis ultrasound, calprotectin