Back Pain in Crohn’s Colitis is a Spondyloarthritis

Imaging spine in Crohn’s Colitis found evidence of spondyloarthritis (active spine arthritis) in 1/2 of cases. Have a case of “arrested” crohn’s disease (there is usually evidence of continued activity in stool secretion – see http://painmuse.org/?p=374 re that) with chronic back pain. She had depression problems so often labelled as nonspecific. More likely it is spondyloarthritis which would respond to steroid injections to sacroiliac and maybe facets.

Acta Radiol. 2017 May;58(5):593-599. doi: 10.1177/0284185116663043.
Prevalence of CT features of axial spondyloarthritis in patients with Crohn’s disease.
De Koc et al.
https://www.ncbi.nlm.nih.gov/pubmed/27552978

  • CT
  • sclerosis [n = 14; 35% ]
    erosions [n = 14; 35%
    ankylosis [n = 3; 8%] 8/40 (8%) patients with CD without inflammatory back pain sclerosis [n = 3; 8%],
    erosions [n = 4; 10%],
    Syndesmophytes [n = 6; 15%]
  • overall, 48% Crohn’s patients showed structural lesion

Comment – there was a recent article showing that radiologists are not great at picking up signs of inflammation so it would be a long journey for any Crohn’s patient. Provocative tests of SI joints would make it stand out. However, referrals to rheumatologists with descriptions of such, are ignored. Good luck to Crohn’s victims

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