Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease

Table 1 Diagnostic criteria according to the ESSG[2]

Inflammatory spinal pain or/and synovitis asymmetric or predominantly of the lower limbs

One or more of the following

Positive family history

Inflammatory bowel disease

Urethritis, cervicitis, or acute diarrhea within 1 mo before arthritis

Buttock pain alternating between right left gluteal areas

Enthesopathy

Sacroiliitis

Table 2 Amor diagnostic criteria for spondylarthropathy[3]

Clinical symptoms or past history of

Lumbar or dorsal pain at night, or lumbar or dorsal morningstiffness = 1

Asymmetric oligoarthritis = 2

Buttock pain (buttock pain = 1, alternating buttock pain = 2)

Sausage-like finger or toe = 2

Heel pain = 2

Iritis = 2

Non-gonococcal urethritis or cervicitis accompanying, or within 1 mo before, the onset of arthritis = 1

Acute diarrhea accompanying, or within 1 mo before, the onset of arthritis = 1

Presence or history of psoriasis and/or balanitis and/or of inflammatory bowel disease (ulcerative colitis, Crohn’s disease) = 2

Radiological findings

Sacroiliitis (grade > 2 if bilateral, grade > 3 if unilateral) = 3

Genetic background

Presence of HLA-B27 and/or family history of ankylosing spondylitis reactive arthritis, uveitis, psoriasis or chronic inflammatory bowel disease = 2

Response to therapy

Definite improvement of musculoskeletal complaints with NSAIDs in less than 48 h or relapse of the pain if NSAIDs are discontinued = 2

A patient is considered as having spondylarthropathy if the sum of the scores is 6 or more

Table 3 Calin’s criteria for the clinical diagnosis of inflammatory back pain[5]

Onset before age 45 yr

Insidious onset

Improvement with exercise

Morning stiffness

Persistence (at least 3 mo)

Coexistence of 4 out of 5 criteria allows the definition of inflammatory back pain

Table 4 Radiologic criteria for staging of inflammatory changes related to sacroiliitis[7]

Sacro-iliac joints
Grade 0	Normal
Grade 1	Suspicious changes
Grade 2	Minimal abnormality-small localized areas with erosions or sclerosis without alterations in joint width
Grade 3	Unequivocal abnormality-moderate or advanced sacro-iliitis with one or more of the following: erosions, sclerosis, widening
Grade 4	Severe abnormality-total ankylosis

Table 5 Early epidemiologic studies on IBD-associated arthropathies

Author	Yr	Population	Patients	AS (%)	SI (%)	Peripheral arthritis (%)	HLA-B27 (%)
Acheson[27]	1960	USA	CD 742	2.3	NA	NA	NA
			UC 1175	2.0	NA	NA	NA
Ansell[28]	1964	Canada	CD 91	6.5	19.7	15.3	NA
Haslock[29]	1973	Great Britain	CD 116	16	NA	20.4	NA
Wright[30]	1965	Great Britain	UC 234	6.4	17.9	NA	NA
Wright[31]	1965	Great Britain	UC 269	5.5	NA	11.5	NA
Dekker-Saeys[20]	1978	Netherlands	CD 51	3.9	15.6	11.7	3.9
			UC 58	3.4	12.0	14.0	18.9
Rankin[32]	1979	USA	CD 569	NA	NA	19.0	NA
Műnch[33]	1986	Germany	CD 167	9.0	20.0	14.0	5.3

NA: Not available; IBD: Inflammatory bowel diseases; CD: Crohn’s disease; UC: Ulcerative colitis; SI: Sacroiliitis.

Table 6 Epidemiologic studies on mixed IBD populations unless otherwise indicated

Author	Yr	Country	Patients	AS1 (%)	SI (%)	Peripheral arthritis (%)	IBD-SpA2 (%)	IBP3 (%)	Enthesopathy (%)	Overall (%)
Scarpa[34]	1992	Italy	79 (UC)	25.3	43	18.9	-	-	-	62
Protzer[35]	1996	Germany	521	45.1	-	28.1	11.5	-	-	-
Veloso[36]	1996	Portugal	792	3.0	-	16.2	-	-	-	-
Orchard[1]	1998	Great Britain	1459	1.0	-	7.4	-	5.2	-	21.4
Suh4[37]	1998	Korea	129	1.6	6.2	15.5	-	-	-	17.1
De Vlam[38]	2000	Netherlands	103 (CD)	3.8	21.84		34.9	30	7	39
Queiro[39]	2000	Spain	62 (UC)	3.2	24.2	30.6	-	-	-	-
Salvarani[2]	2001	Italy, Netherlands	160	2.6	3.6	10.6	18.1	8.8	10	33.1
Christodoulou5[40]	2002	Greece	252	-	5.9	2.8	-	-	-	17.0
Palm6[41]	2002	Norway	406	2.4	2.0	17	22	18.0	26	32.5
Mendoza[42]	2005	Spain	566	1.8	1.9	6.7	-	-	-	-
Turkcapar[3]	2006	Turkey	162	9.9	45.7	14.8	45.7	-	50.0	-
Peeters[43]	2008	Belgium	251 (CD)	6	27	29	-	-	-	-
Rodriguez[44]	2008	Puerto Rico	100	2.6	13	5	42	42	-	-
Lanna[45]	2008	Brazil	130	6.2	9.2	25.4	-	10	5.4	31.5

¹Modified New York criteria;

²IBD-SpA according to ESSG criteria;

³Calin’s criteria;

⁴Classification according to Gravallese[62]; ⁵Only symptomatic SI, X-ray assessment; Undefined arthralgia group; no definitions are given for spondylitis or arthritis; ⁶IBP and SI were considered excluding patients with AS; asymptomatic patients included in SI.