New Algorithms Guide Management of Back Pain, Arthropathy in IBD

NEW YORK (Reuters Health) - Belgian gastroenterologists and rheumatologists have joined forces to develop practical algorithms for managing chronic back pain and peripheral arthropathies in patients with inflammatory bowel disease (IBD).



"We believe the section on chronic back pain is very important, as simply by enquiring about the pain pattern and the treatment patients are on, inflammatory back pain can be identified," Dr. Martine De Vos of Ghent University Hospital, in Belgium, told Reuters Health by email.

Chronic back pain, large-joint monoarthritis and arthralgia are common extraintestinal manifestations of IBD.


Dr. De Vos and colleagues conducted several meetings to arrive at consensus referral algorithms for patients with IBD who present with joint symptoms.

For patients with chronic back pain, clinicians must first rule out septic spondylodiscitis or spinal tuberculosis, which require urgent referral to the emergency department, the team says.

The algorithm then divides patients according to the presence or absence of inflammatory back pain, followed by treatment with up to two weeks of nonsteroidal anti-inflammatory drug (NSAID) therapy. Further treatment or referral depends upon the response to NSAIDs.

Similarly, septic arthritis must first be ruled out in IBD patients who present with large joint monoarthritis, the authors explain in Alimentary Pharmacology and Therapeutics, online October 25. For those without septic arthritis, diagnostic articular puncture results are used for further triage to therapy or referral.

The referral pattern for IBD patients with oligo- or polyarticular arthritis depends upon the distribution - symmetrical or asymmetrical - of the arthritis, whereas the algorithm for patients with recurrent or long-standing arthralgia follows one of two paths based on whether the pain appears to be inflammatory or mechanical.

"The proposed strategies allow a clear evaluation for referral based on basic clinical criteria in combination with laboratory tests to identify which patients should be referred to emergency room, physical medicine, or rheumatologist," the authors note. "The proposed strategies are specific enough to evaluate IBD patients with joint symptoms without overloading rheumatologists with unnecessary referrals."

"All recommendations were agreed by a panel of opinion leaders in rheumatology and gastroenterology," Dr. De Vos explained. "Nevertheless, the use and proposed dose of NSAIDs in IBD may remain controversial."

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