Ultrasonographic and clinical assessment of peripheral enthesitis and arthritis in an Italian cohort of inflammatory bowel disease patients

Elena Bertolini, Pierluigi Macchioni, Fernando Rizzello, Marco Salice, Gentiana Vukatana, Gilda Sandri, Angela Bertani, Giovanni Ciancio, Marcello Govoni, Angelo Zelante, Nazzarena Malavolta, Marina Beltrami, Carlo Salvarani

Research output: Contribution to journalArticlepeer-review


Aims: To evaluate the prevalence of clinical and ultrasonographic musculoskeletal involvement in Italian patients with inflammatory bowel disease (IBD). Methods: In this cross-sectional multicenter study, 148 consecutive patients with IBD were evaluated by a gastroenterologist and a rheumatologist. All patients underwent a B-mode and power Doppler ultrasonographic examination of 6 pairs of entheses and of knee and ankle joints. Results: A positive history for at least one musculoskeletal manifestation was reported by 40.5% of patients, more frequently in ulcerative colitis (UC) (p = 0.033). Inflammatory back pain was reported by 13.5% of patients, and a past history of peripheral arthritis by 14.9%, entheseal inflammation by 14.2% and dactylitis by 2.7%. At clinical examination, arthritis was observed in 19.6% of patients and enthesitis in 33%. Oligoarthritis and enthesitis at clinical examination were more frequently observed in UC than in Crohn disease (CD). 37.8% of total IBD patients fulfilled ASAS classification criteria for axial and/or peripheral spondyloarthritis, 8.1% ASAS classification criteria for axial spondyloarthritis, and 29.7% ASAS classification criteria for peripheral spondyloarthritis. With ultrasonographic examination, signs of entheseal involvement were observed in 87.8% of patients, while at power Doppler, ≥1 abnormality was observed in 27.1%. ASAS+ patients compared to those ASAS- had a significantly higher frequency at ultrasonography of acute entheseal abnormalities, power Doppler entheseal positivity and joint involvement. These abnormalities at ultrasonography were also observed in 34%, 13% and 12% of ASAS- patients. Conclusions: Musculoskeletal manifestations occur frequently in patients with IBD. Ultrasonographic entheseal and joint involvement were also observed in asymptomatic patients.

Original languageEnglish
Pages (from-to)436-443
Number of pages8
JournalSeminars in Arthritis and Rheumatism
Issue number3
Publication statusPublished - Jun 2020


  • Clinical examination
  • Enthesitis
  • Inflammatory bowel disease
  • Spondyloarthritis
  • Ultrasonography

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine


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