Musculoskeletal manifestations in a population-based cohort of inflammatory bowel disease patients

Background: Musculoskeletal disorders are the most common extra-intestinal manifestation of inflammatory bowel disease (IBD). Wide ranges of prevalenc e have been reported depending on the criteria used to define spondylarthro pathy and on the selection of patients. We aimed to evaluate the prevalence and clinical spectrum of musculo skeletal manifestations in an inception c ohort of European IBD patients. Methods: From 1 October 1991 to 30 Septembe r 1993, 202 IBD patients were diagnosed in three centres of two countries ( Italy and The Netherlands) by means of a population-based inception cohort study. Of this group of patients, 160 (79%) were interviewed and examined b y a rheumatologist and a gastroenterologist in the period June-September 19 96. A total of 139/160 patients had an anteroposterior radiograph of the pe lvis, and in 140/160 HLA-B27 was determined. Results: 53 (33.1%) of the 160 patients had experienced at least one musculoskeletal manifestation, 29 (1 8.1%) satisfied the European Spondylarthropathy Study Group (ESSG) criteria for spondylarthropathy and 5 (3.1 %) satisfied the modified New York crite ria for ankylosing spondylitis. However, 23 (14.4%) patients developed one or more spondylarthropathy-related manifestations without fulfilling. any o f the classification criteria. In patients satisfying ESSG criteria a signi ficantly higher frequency of women (P = 0.03), of ocular and liver involvem ent (P = 0.01 and P = 0.03, respectively), and use of immunosuppressive dru gs (P = 0.02) was observed. Conclusion: Our study shows a high prevalence o f musculoskeletal manifestations in an inception cohort of IBD patients. Th e clinical spectrum is broader than that defined by spondylarthropathy crit eria.