Management of Musculoskeletal Manifestations in Inflammatory Bowel Disease

Table 2

Musculoskeletal manifestations in IBD.

	Salient features	Prevalence
Peripheral arthropathies
Type 1 peripheral arthritis	Oligoarticular; Asymmetric; Large joints of lower extremities; Self-limiting; Nonerosive; Parallels disease activity; Associated with HLA-B27 carriage	3.6–6%
Type 2 peripheral arthritis	Polyarticular; Symmetric; Small joints of upper extremities; Progressive; Erosive; Independent of disease activity; No association with HLA-B27	2.5–4%
Arthralgia without arthritis	Pain without swelling or erythema	5.3–16%
Enthesitis	Pain and swelling at the tendon insertion site	6–50%
Dactylitis	Pain and swelling of the entire digit	2–4%
Axial arthropathies
Inflammatory back pain	Insidious onset; Back pain lasting > 3 months; After periods of inactivity; Associated with stiffness; No associated radiological findings	17–22%
Isolated sacroiliitis	Imaging studies showing erosion, or sclerosis of the sacroiliac joints; May be asymptomatic; HLA-B27 negative	16–46%
Ankylosing spondylitis	Combination of inflammatory back pain and imaging studies showing bilateral sacroiliitis grade ≥ 2 or unilateral sacroiliitis grades 3-4	1–11.4%
Other
Fibromyalgia syndrome	Generalized body pain for ≥3 months; 11 out of 18 tender points	3–3.7%
Osteopenia	BMD -score ≤ −1.0	32–36%
Osteoporosis	BMD -score ≤ −2.5	7–15%
Osteonecrosis	Marrow infarction; Most common site head of femur	<0.5%
Myopathy	Multifactorial in etiology	Rare
Orbital myositis	Localized inflammation of extra-ocular muscles	Rare
Gastrocnemius myalgia syndrome	Calf pain as presenting complaint; Gastrocnemius muscle involvement	Rare

BMD: bone mineral density.
Table is reproduced from Sheth et al. [1] with permission from Lippincott Williams and Wilkins.