Magnetic resonance imaging of the peripheral joints of patients with inflammatory bowel diseases with arthralgia

Inflammatory bowel diseases (IBD), Crohn*s disease (CD) and ulcerative colitis
(UC), are associated with a variety of extraintestinal manifestations. The most
common extraintestinal manifestation, articular involvement, occurs in 16% to
33% of IBD patients (1-7). These arthropathies may increase morbidity,
resulting in a worse quality of life compared with inflammatory bowel disease
patients without arthropathies. Arthropathy in IBD patients is clinically
divided into peripheral and axial involvement. Arthritis associated with IBD is
one of the diseases captured under the umbrella of spondyloarthritis (SpA).
Spondyloarthritis is a group of inflammatory diseases with overlapping features
and is linked to Human Leukocyte Antigen-B27. Arthralgia is (non-inflammatory)
joint pain without objective evidence of swelling or effusion and has been
excluded in most studies on arthropathy in IBD patients. The prevalence of
arthralgia in IBD patients range from 8 to 30% (6,8,9). In 2005, a study (9)
showed that IBD patients with non-inflammatory joint pain had a significantly
lower health related quality of life (HRQOL assessed by SF-36 and IBDQ) score
indicating a worse health related quality of life compared with IBD patients
without arthralgia, thus representing a major medical problem in IBD patients.
Little is known about the pathophysiology of peripheral arthralgia and
arthritis in IBD patients. The binding of activated intestinal lymphocytes in
IBD patients to inflamed synovial vessels can provide an explanation for the
pathogenesis of joint inflammation in IBD patients.
Peripheral arthritis in IBD patients is usually nondeforming and nonerosive
(10). Therefore, radiographs of peripheral joints do not show erosions. To our
knowledge no studies have been published about imaging of the painful
(non-inflammatory) joints in IBD patients and therefore, the presence of
subclinical inflammation or bone marrow changes in IBD patients is unknown.
MRI is a highly sensitive imaging technique which provides high anatomical
details and identifies the more subtle changes of arthritis, which are
invisible on plain film, such as synovitis, synovial hypertrophy, joint fluid,
bone marrow oedema, small bone erosions and cartilage destruction (11,12).
Our hypothesis is that edema like bone marrow changes will be present in
painful joints in IBD patients without arthritis, not present in the control
group. The aim of our study is to evaluate the presence of anatomical changes
in painful joints in IBD patients with a dedicated peripheral extremity MR
scanner.

To evaluate the presence of anatomical changes in painful joints in IBD
patients with a dedicated peripheral extremity MR scanner.

The study is initiated by the departments of Gastroenterology & Hepatology,
Radiology and Rheumatology of the Leiden University Medical Center, Leiden, the
Netherlands.
The study is a single center observational case-control study.

Reactions to gadolinium contrast media is reported in less than 1% in patients
who underwent MR imaging. Common reactions are: sneezing, (temporary) headache,
urticaria (hives) and nausea.