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Low Back Pain, Sacroiliitis, and the Relationship with HLA-B27 in Crohn's Disease
SOPHIA STEER, HUGH JONES, JANE HIBBERT, ELLI KONDEATIS, ROBERT VAUGHAN, JEREMY SANDERSON, and TERENCE GIBSON
ABSTRACT. Methods. A total of 134 consecutive patients with CD completed a questionnaire about musculoskeletal symptoms. Those reporting low back pain were assessed, including plain radiographs and CT of the sacroiliac joints. HLA-B27 status was determined in patients with and without back pain. Results. There were 70 (52%) patients with low back pain, of whom 31 (45%) had CT evidence of sacroiliitis. These were characterized by more frequent morning spinal stiffness and positive sacroiliac compression tests even when sacroiliitis was not suspected. Nine had previously recognized radiological and clinical ankylosing spondylitis (AS), and of these 78% were HLA-B27 positive. Of those with newly identified sacroiliitis, 14% were HLA-B27 positive. This frequency was not statistically dissimilar to the 9% HLA-B27 positivity of those without back pain. Conclusion. Sacroiliitis defined by CT is a common cause of low back pain in CD. A relationship of sacroiliitis and HLA-B27 could be confirmed only for those with classical AS. Our results accord with the possibility that sacroiliitis in CD is an isolated phenomenon, which is unrelated to HLA-B27 and which may evolve into classical spinal ankylosis in genetically susceptible subjects. (J Rheumatol 2003;30:518-22) Key Indexing Terms:
CROHN'S DISEASE
From Guy's and St. Thomas' Hospitals NHS Trust, London, UK. Dr. Steer is partly supported by the Arthritis Research Campaign, UK. S. Steer, MA, MRCP, Lecturer, Guy's Kings and St. Thomas' Medical School; E. Kondeatis, MSc, Clinical Scientist; R. Vaughan, PhD, Director of Tissue Typing, S. Thames Tissue Typing Laboratory, Guy's Hospital; J. Sanderson MD, FRCP, Consultant Gastroenterologist; T. Gibson, MD, FRCP, Consultant Physician, Guy's and St. Thomas' NHS Trust; H. Jones, MB, MRCP, Consultant Physician, Kingston Hospital NHS Trust; J. Hibbert, MRCP, FRCR, Consultant Radiologist, Ashford and St. Peter's Hospital NHS Trust. Address reprint requests to Dr. T. Gibson, Department of Rheumatology, Guy's Hospital, London SE1 9RT, England. E-mail: terence.gibson@kcl.ac.uk Submitted December 5, 2001; revision accepted August 16, 2002. |