Recent MRI study of crohn’s colitis patients found 17/44 cases had evidence to sacroiliitis and 11 of these had back pain. HLA B27 is seen in 10% of the population. If present in any of the crohn’s patients (were in 7) – they all had sacroiliitis. This means that 11/44 = 25% of Crohn’s patients will have spine arthritis which is over twice the rate in the normal population. There are significant delays in diagnosis.
Power to be had decreed that HLA B27 testing should only be ordered by by Rheumatologists, some who don’t do them because they don’t believe it helps. MRI’s similarly can only be done by specialists and I would be suspect that they may not be read properly by radiologists as had a flagrant case was missed recently on plain Xray. This would mean Crohn’s patients with spondylitis will go undiagnosed for years as was the case I saw in the last week. Crohn’s itself requires several years for proper diagnosis and if they are diagnosed with irritable bowel, it could be longer.
Comment – got diarrhea and chronic pain? Any GI illness seems to cause psoas spasm and hence back pain. With crohn’s (and colitis in general) you can get MRI observable sacroiliitis that could be diagnosed by HLA B27 testing and MRI but are made unavailable. This is doing medicine from that last century. Given that remacade helps the back, lack of diagnosis means lack of effective treatment as well.