POS0155 PERIPHERAL JOINT AND ENTHESIS INVOLVEMENT IN NEWLY DIAGNOSED PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD): SYMPTOMS, CLINICAL AND ULTRASONOGRAPHIC FINDINGS

Background Peripheral musculoskeletal (MSK) symptoms are the most common extra intestinal manifestations (EIMs) in IBD patients, with substantial impact on quality of life. IBD related spondyloarthritis (IBD-SpA) often requires a multidisciplinary evaluation to enable optimal choice of treatment and patient care, but systematic rheumatological characterisation of this population is scarce [1]. Characterisation of IBD-SpA is challenged by the variety of MSK involvement (from arthralgia to ankylosing spondylitis), the co-existence of osteoarthritis, overuse enthesopathies or fibromyalgia, and by the heterogeneity in methodologies used to describe the SpA features. Recently developed recommendations for endpoints for EIMs in IBD trials [2] were applied in the present study. Objectives To determine the prevalence and distribution of inflammatory lesions in peripheral joints and entheses in newly diagnosed IBD patients, assessed for presence of MSK symptoms, and by rheumatological and ultrasound (US) evaluation. Methods Patients from the IBD prognosis inception cohort (IBD-Pro) were consecutively included [2]. They reported MSK symptoms using a validated questionnaire (IBD-TASQ). A clinical examination was performed by rheumatologist, as was US examination (grey scale (GS) and colour Doppler (CD)) of 38 peripheral joints and 14 entheses, applying OMERACT-EULAR definitions and scoring systems for synovitis and enthesitis [3]. Synovitis was defined as GS score ≥2 and/or CD≥1 and entheseal inflammation was defined as presence of hypoechogenicity/thickening and/or CD score ≥1. Further, OMERACT-EULAR sum score (GLOESS) was calculated (0-114). Results 110 newly diagnosed IBD patients (mean age 42, 39% male) were included (34% Crohn’s disease, 59% ulcerative colitis (UC), 5% unclassified IBD). The IBD disease activity scores indicated mild activity in UC patients (Simple Clinical Colitis Activity Index mean (SD) 6.7 (3.6) - max score 19, and low in Crohn (Harvey-Bradshaw Index for Chron’s disease 4.5 (2.9)- max score 18). Four patients received systemic glucocorticoids (2%) or biologics (2%) at the time of rheumatological evaluation. History of psoriasis was reported in 2% and uveitis in 5% of the patients. 40% of the patients reported positive history for ≥1 MSK symptom (Figure 1, A1); joint pain and swelling were the most common complaints (30%), followed by heel enthesitis (17%) and dactylitis in 20%. Patient pain VAS was low, mean (SD) 13(25). Clinical examination revealed 53% of all patients having arthritis and/or enthesitis and fulfilled ASAS classification criteria for peripheral SpA (25% ≥1 tender joint, 12% ≥1 swollen joint, 46% ≥1 tender enthesis, 38% both ≥1 tender/swollen joint and ≥1 tender enthesis). Figure 1 (part A2a, A2b) shows joint and enthesis involvement. US found inflammation in ≥1 joint or enthesis in 47% of the IBD patients - synovitis in 30%, mean GLOESS sum score 5.2 SD (4.6) and entheseal inflammation in 33% (US enthesitis sum, mean (SD) 2.6(2). (Figure 1, part A3a, A3b). Among those patients reporting entheseal pain, 71% had ≥1 tender enthesis at clinical evaluation and 64% had entheseal inflammation by US. Among those reporting joint pain, 55% had ≥1 tender or swollen joint, and 41% US synovitis. Figure 1 (part B1, B2) displays the overlap between patient-reported symptoms, clinical and US findings. In the asymptomatic patients (60 %) 59% of the patients with clinical signs of arthritis and 79% of those with enthesitis were asymptomatic. US enthesitis and synovitis were also observed in 69% and 58%, respectively, of the asymptomatic patients. Conclusion At the time of IBD diagnosis 53% fulfilled ASAS classification criteria for peripheral SpA and 47% had objectively verified synovitis and/or enthesitis by US indicating that SpA may be underdiagnosed among IBD patients. References [1]Schwartzman M et al., RMD Open 2022 [2]Guillo L et al., Lancet Gastroenterol Hepatol 2022 [3]Bruyn GA et al., The Journal of Rheumatology 2019 [4]Attauabi M, et al., BMJ Open 2022 Acknowledgements The authors would like to thank all participating patients, physicians, study nurses and secretaries who contributed to this study. Disclosure of Interests Nora Vladimirova Speakers bureau: MSD, Grant/research support from: Novartis, Lene Terslev Speakers bureau: Speakers fees from Janssen, Roche, Novartis, Pfizer, UCB, GE and Eli-Lilly, Consultant of: consultancy fee from Janssen and UCB, Mohamed Attauabi: None declared, Gorm Madsen Speakers bureau: Bristol Myers Squibb and Tillots Pharma., Viktoria Fana: None declared, Charlotte Wiell: None declared, Uffe Møller Døhn: None declared, Jacob Jørgensen: None declared, Flemming Bendtsen Grant/research support from: Ferring and Tillotts, Jakob Seidelin Grant/research support from: Research grants from Takeda and the Capital Region Denmark, national coordinator of studies from AbbVie, Arena Pharmaceuticals, Ely Lilly, and Boehringer Ingelheim., Johan Burisch Speakers bureau: AbbVie, Janssen-Cilag, Celgene, MSD, Pfizer, Takeda, Tillots Pharma, Samsung Bioepis, Bristol Myers Squibb, Novo Nordisk, Pharmacosmos, Ferring, Galapagos, Grant/research support from: Janssen-Cilag, MSD, Pfizer, Takeda, Tillots Pharma, Bristol Myers Squibb, Novo Nordisk, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Gilead, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB., Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Gilead, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB., Grant/research support from: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Gilead, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB.

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