1555: Axial Spondyloarthritis in Patients with Gastrointestinal Involvement of Behçet Syndrome

Musab Ozturk¹, Sinem Nihal Esatoglu², Ibrahim Hatemi³, Aykut Ferhat Celik³, Osman Aykan Kargin⁴, Ahmet Oz⁴, Erkan Yilmaz⁵, Didar Ucar⁶, Melike Melikoglu², Hasan Yazici⁷, Ibrahim Adaletli⁴ and Gulen Hatemi², ¹Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Department of Internal Medicine, Istanbul, Turkey, ²Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey, ³Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Department of Internal Medicine, Division of Gastroenterology, Istanbul, Turkey, ⁴Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Department of Radiology, Istanbul, Turkey, ⁵Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Tissue Typing Laboratory, Istanbul, Turkey, ⁶Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Department of Ophthalmology, Istanbul, Turkey, ⁷Academic Hospital, Istanbul, Turkey

Background/Purpose: Controlled studies have shown that radiographic sacroiliitis was not increased in Behçet syndrome (BS), compared to other inflammatory diseases. However, gastrointestinal involvement of Behçet syndrome (GIBS) shares common features with inflammatory bowel disease which, in turn, can be associated with spondyloarthritis (SpA). We wanted to see whether GIBS patients have an increased frequency of radiographic sacroiliitis or non-radiographic axial spondyloarthropathy (nr-AxSpA) compared to BS patients with only mucocutaneous and/or joint involvement with no major organ involvement.

Methods: We included 71 GIBS patients and 76 consecutive BS patients without major organ involvement. Patients were screened for axial spondyloarthritis (axSpA) using the Assessment of Spondyloarthritis International Society (ASAS) criteria. First they were questioned for chronic back pain, defined by ASAS as the presence of chronic back pain for more than 3 months and an age at onset of < 45 years. Patients with chronic back pain were questioned for other spondyloarthritis features and tested for HLA-B27 status, CRP levels and X-ray and magnetic resonance imaging of the sacroiliac joints. All radiologic images were evaluated independently and blind bytwo radiologists.

Results: Chronic back pain was reported by 30 (42%) GIBS patients and 25 (33%) BS patients with only mucocutaneous and/or joint involvement (p=0.24). Five (7%) GIBS patients and 4 (5%) controls met ASAS criteria for axSpA (p=0.74). Only 1 GIBS patient had radiographic axSpA (also termed ankylosing spondylitis), whereas 4 GIBS patients and 4 patients among the controls had nr-AxSpA. HLA B27 was positive in 3 (4%) of the GIBS patients and in 5 (7%) of the controls (p=0.72). There were no significant differences between the groups regarding other SpA features of the ASAS criteria (Table).

Conclusion: The frequency of axSpA in GIBS patients was not found to be higher than that in BS patients who have only mucocutaneous and/or joint involvement. This finding further suggests that, despite certain clinical similarities between GIBS and Crohn's disease, different disease mechanisms may be involved.




M. Ozturk: None; S. Esatoglu: None; I. Hatemi: None; A. Celik: None; O. Kargin: None; A. Oz: None; E. Yilmaz: None; D. Ucar: None; M. Melikoglu: None; H. Yazici: None; I. Adaletli: None; G. Hatemi: None.