DISTINGUISHING FEATURES OF MUSCULOSKELETAL SYSTEM EXTRAINTESTINAL MANIFESTATIONS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract

Inflammatory bowel diseases (IBDs) that are accompanied by extraintestinal manifestations often lead to complications, contribute to deterioration of the quality of life and are difficult to diagnose. Therefore, the purpose of our research was to investigate the distinguishing features of the spine and joints lesions in patients with ulcerative colitis (UC) and Crohn’s disease (CD), which are the most frequent extraintestinal manifestations of the forenamed diseases, and to investigate the possible link between the gut microbiota dysbiosis and the disease activity. The data of 73 patients with IBDs, whose average age was 38,6±6,9, were analyzed in this research. Among the examined patients the first group consisted of 29 (39,7%) patients with IBDs and lesions of the spine and joints and the second group consisted of 44 patients without changes in the musculoskeletal system. UC was diagnosed more frequently – in 58 (79,5%) patients, – and CD was diagnosed in 15 (20,5%) patients; the large intestine lesions were detected significantly more often (р<0,05). The diagnosis was made according to the international clinical, instrumental and histological criteria. The diagnosis of the spine and joints lesions in patients with IBD was made according to the expert ECCO guidelines (2018). Significantly more often the peripheral joint syndrome was diagnosed – in 25 (86,5%) cases, with large joints lesions – in 22 (75,9%) cases (p<0,05), and frequently – monoarthritis of lower limbs. The lesions of three and more joints were detected in 8 (27,6%) patients who had higher disease activity and usually worse course of disease – in 7 (87,5%) patients. Axial type was diagnosed significantly more rarely – only in 4 (13,8%) patients (p<0,03), isolated sacroiliitis predominated in 3 (10,3%) patients. According to the findings, the spine and joints lesions were diagnosed significantly more often in patients with medium severity course and severe course of IBDs that were accompanied by total lesions during UC and by intestinal obstructions, fistulae and abscesses during CD – in 20 (68,9%) cases, – in contrast to the patients without joint syndrome – 13 (29,6%) patients (r=0,76) (р<0,02). Particularly notable is the increase in platelets in the group of patients with the lesions of joints and spine. The platelet count was on average 469±12,3х109 /l per liter in contrast to the patients of the second group – 318±14,1 х109 /l (р<0,03). In addition, it was detected that in lesions of joins and spine there was a significant increase in ESR (more than 50 mm/hour) – in 25 (86,2%) patients, 28 (63,6%) cases – in the second group correspondingly. A significant difference was determined after detecting calprotectin with the quantitative assessment method. Thus, calprotectin values in the first group of patients were on average 306,9±16,4µg/g in contrast with the patients of the second group – 154±17,1 µg/g (р<0,05), which proved higher activity of the process in patients with the extraintestinal manifestations and necessity of the therapy intensification. Apart from that, the microbiota dysbiosis was detected more often in the first group. Thus, decrease in Lactobacillus abundance and increase in opportunistic microflora was detected significantly more often – in 22 (75,9%) patients (p<0,05) and in 27 (93,1%) patients (r=0,73) (р<0,01) correspondingly. Furthermore, decrease in abundance of Escherichia coli with normal enzymatic properties was detected and it was more pronounced in the group of patients with musculoskeletal disorders – 27 (93,1%) patients (p<0,05). Significant increase in opportunistic microflora, decrease in Lactobacillus abundance and abundance of Escherichia coli with normal enzymatic properties, which were detected in patients with IBDs and lesions of spine and joints, is without doubt an additional factor that can amplify the inflammatory changes in intestines and have a negative impact on therapy of these patients.

Keywords

• inflammatory bowel diseases
• extraintestinal manifestations
• joints
• spine
• inflammation activity
• dysbiosis.