Background: More than one third of inflammatory bowel disease patients (IBD) present extraintestinal manifestations, with articular manifestations being the more common, clearly the more incapacitating and which more alter the quality of life of IBD patients. These patients could benefit from a multidisciplinary approach for quicker diagnosis and for optimizing treatments. The aim of the study was to evaluate the impact of a multidisciplinary approach carried out by both a rheumatologist and a gastroenterologist in the management of these patients.
Methods: From April 2015 to October 2016, all IBD patients reporting articular pain to the IBD-dedicated gastroenterologist were referred to an experienced rheumatologist. The day of the consultation a multidisciplinary committee with a rheumatologist and a gastroenterologist evaluated and discussed in all patients their possible diagnosis and potential changes in their treatment. Assessment was made according to current guidelines and data recorded in a common database regarding the reasons why patients were remitted from IBD, their rheumatologic diagnosis and all changes implemented in their treatments. Results are shown in percentages.
Results: 82 consecutive IBD patients were remitted from the IBD Unit and analyzed by the committee. Mean age 38 years (ranging from 18 to 73). Most patients were women (73%), 19% were smokers and 23% former smokers. 49% had Crohn's disease and 51% ulcerative colitis. The main causes for derivation from IBD were a suspicion of inflammatory arthropathies in 43% and of arthromyalgias in 40%. The more frequent diagnosis after the rheumatology consultation and the committee meeting were inflammatory arthropathies associated with IBD in 41% (52% presented axial arthropathies and 48% presented peripheral arthropathies) and fibromyalgia in 15%. Regarding treatment changes, after the multidisciplinary committee with a rheumatologist and a gastroenterologist, changes were made in 18 patients (22%). In 7 patients methotrexate was added in patients with biologic treatment (in some of them patients were in monotherapy, but in others the drug was introduced for replacing thiopurines). In 6 patients sulfasalazine was introduced instead of mesalamine. In the other patients either other biologics like ustekinumab were introduced or the doses of anti-TNF were optimized in accordance with rheumatologic schedules.
Conclusions: A multidisciplinary consultation combining inflammatory bowel disease and rheumatology allows both an earlier detection of inflammatory arthropathies associated with IBD and earlier changes in treatment, thereby helping to optimize the hospitality resources. Fibromyalgia is common among IBD patients and should not be confused with inflammatory arthropathies.