David Hudesman, MD, on Sacroiliitis in Patients With IBD

David Hudesman, MD, discusses research he and colleagues conducted to identify the prevalence and disease characteristics associated with sacroiliitis among patients with Crohn disease undergoing magnetic resonance enterography.

David Hudesman, MD, is codirector of the Inflammatory Bowel Disease Center at NYU-Langone Health in New York City.

Additional Resource:

Levine I, Malik F, Castillo G, et al. Prevalence, predictors, and disease activity of sacroiliitis among patients with Crohn's disease. Inflamm Bowel Dis. Published online August 14, 2020. https://doi.org/10.1093/ibd/izaa198

Transcript:

David Hudesman:  Hi. I’m Dr David Hudesman, codirector of the Inflammatory Bowel Disease Center at NYU Langone Health and associate professor of medicine. I’m going to be speaking to you about a study my team here at NYU put together and was just published online in Inflammatory Bowel Diseases, looking at the prevalence and also predictors of sacroiliitis in Crohn disease.

Extraintestinal manifestations is something that’s relatively common in our patients with IBD, something that could be difficult to treat and also difficult to diagnose if we’re not asking the right questions. If you look specifically at arthralgias and arthritis, some studies show up to 40% to 50% of our patients will have one of those two — arthralgias or arthritis.

More so, central spondyloarthropathies, ankylosing spondylitis, sacroiliitis, this could lead to long-term debilitating issues for our patients. If you look at ankylosing spondylitis, anywhere from about 2% to 4% of our IBD patients will have that.

Sacroiliitis, depending on what study you look at, whether it’s symptomatic or picked up on a random imaging study, x-ray, MR, or CT, could range anywhere from 10% and in some studies, as high as 40% or so.

Furthermore, why this is important is it’s great we have more therapeutic options for our patients with inflammatory bowel disease. We have more targeted therapies like vedolizumab and ustekinumab in addition to our anti-TNF agents as well as tofacitinib, one of our JAK inhibitors.

However, if we’re treating somebody with central spondyloarthropathy — and we know that, and we’re looking for that — [who] also have IBD, we’re going to pick something different than if somebody only has IBD. For example, something that’s more targeted like vedolizumab is not going to do as well for central spondyloarthropathy.

For all of these reasons, it’s important for us to be on the lookout to diagnose extraintestinal manifestations and then also understand how we should manage these patients. What our study did is it took a little over about 258 patients that had MR enterographies for their Crohn disease. What we wanted to see is, can MR enterography accurately diagnose sacroiliitis so we don’t have to put our patients through an extra imaging study focused on those SI joints? What we found was out of our 258 patients or so, 17% of them had evidence of sacroiliitis. Over three-quarters of that was defined by having bone marrow edema.

We had the imaging reviewed by both GI radiologists from the Crohn disease perspective as well as musculoskeletal radiologists, and they were blinded to the clinical picture.

What we also wanted to do is to see, what were the predictors of sacroiliitis? We looked at disease activity, both clinical factors using HBI and the Crohn Disease Activity Index, CDAI. We also looked at the SES-CD or the endoscopy score. We looked at the MaRIA score for imaging and trying to see if that was associated with any risk factors for sacroiliitis or severity.

Pretty much what we found was the age as well as a history of back pain were the only two good predictors for sacroiliitis on imaging, whether they were on biologics or not, anti-TNF or not.

But what I think what our study has shown that this is relatively common, and it is something that we can pick up on our MR enterographies. The take-home point is when you’re ordering these studies for your patients with Crohn disease, talk to your radiologist and making sure you’re looking at those joints, because knowing if the patient has sacroiliitis or any other central spondyloarthropathy will help guide our treatment decision. 

Thank you.