Inflammatory Bowel Disease Related Joint Manifestations: Incidence, Types, Relation to Disease Activity and Types of Treatment

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Ahmed, Nabwia M. Tawfik, Mohamed A. A. Abozaid, Youstina Y. Soliman, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8507984/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Two chronic gastrointestinal disorders that make up inflammatory bowel disease (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The disease has extraintestinal affection including articular which is the most common, ocular, dermatologic, pulmonary, biliary and haemtologic. Purpose of the study: The study aimed to identify incidence and types of musculoskeletal symptoms associated with IBD; relation to IBD activity, lines of treatment used and efficacy of drugs in prevention and treatment of these joint manifestations. Methods A cross-sectional hospital-based study conducted on 150 patients diagnosed with IBD based on clinical, laboratory, radiological, endoscopic and histopathological data. Detailed history, examination and complete investigations including colonoscopy, histopathology, pelvic and lumbosacral x-ray were performed. Results A total of 150 patients were included, 131 patients had UC, 19 patients had CD, 50 (33.3%) patients had joint affection, and 100 (66.7%) patients didn't have joint affection. A total of 23 (46%) patients had axial affection, and 20 (40%) patients had peripheral affection. Meanwhile, 7 (14%) patients had both affections. Majority (60%) of patients had less than five affected joints, and 20 (40%) patients had more than five joints affection. At the same time, 43 (86%) patients had no peripheral symptoms. Conclusion Joint manifestations fairly common in patients with IBD (33.3%). Patients with longer duration of the disease, female gender and more active severe disease were more liable to develop joint affection. Type of IBD, either CD or UC, and its lines of therapy had no correlation with occurrence of joint manifestations. Inflammatory Bowel Disease Crohn’s Disease Ulcerative Colitis Musculoskeletal Joint Figures Figure 1 Figure 2 Background One chronic inflammatory disorder that affects the digestive tract is inflammatory bowel disease (IBD). As a group, Crohn's disease (CD) and ulcerative colitis (UC) are the two most common forms. Now, it is clear that IBD can also cause problems outside of the digestive tract. These are called extra-intestinal manifestations (EIMs), and they can affect the joints, eyes, skin, lungs, bile system, and blood [ 1 , 2 ] . A key part of the problem in IBD is when the immune system reacts abnormally to bacteria in the gut and/or what these bacteria produce. Studies have shown links between gut bacteria, certain genes a person may have, and how sick someone ends up being [ 3 , 4 ] . The natural progression of the disease is marked by cycles of recurrence and remission, driven by several factors such as genetic predisposition, environmental conditions, and lifestyle choices, among others. A subgroup of seronegative SpA, along with ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), and undifferentiated SpA, was previously thought to include arthropathy linked with inflammatory bowel disease (IBD) [ 1 ] . Musculoskeletal manifestations specifically include the peripheral arthropathy by its both types pauciarticular and involves multiple joints and affect the spine, including sacroiliitis (SI), which might also involve inflammation of the vertebrae, similar to idiopathic AS [ 5 ] . Arthritis is joint involvement predominant kind in IBD patients, affecting roughly 30% of individuals, but SI and AS are less frequently detected, occurring in about 3.1% and 1.1% of people, respectively [ 6 ] . Although the incidence of SpA does not differ significantly between UC and CD, it appears to be more common in ulcerative pancolitis and chronic intermittent or continuous symptoms in UC patients. Common extraintestinal symptoms that accompany peripheral arthritis include erythema nodosum and anterior uveitis [ 7 ] . The rheumatological manifestation could be a cause to change the line of management which is positioning of biological treatment. The treatment can be either conventional or biological. The therapy objectives for musculoskeletal manifestations of IBD are to diminish inflammation and to avert impairment or deformity. Nonsteroidal anti-inflammatory medicines (NSAIDs) are typically recommended to manage peripheral arthritis, back pain, and stiffness.Sulfasalazine, azathioprine, 6-mercaptopurine, methotrexate, as well as glucocorticoids may be beneficial for inflammation of both the gut and joints. Intraarticular glucocorticoid injections may be utilized for exacerbation of peripheral arthritis. However, amino salicylates (e.g. mesalamine), beneficial for regulating intestinal inflammation, appear to have no direct anti-inflammatory action on the synovium .Anti-TNF monoclonal antibodies (infliximab, adalimumab) are effective in IBD notably CD, and are beneficial for individuals with axial involvement and peripheral arthritis [ 8 ] . Patients with IBD and genuine AS who have an insufficient response to standard therapy are eligible for anti-tumor necrosis factor alpha (TNFα) medication. Infliximab, adalimumab, etanercept, and golimumab (human monoclonal antibody, 50 mg administered subcutaneously once monthly) are applicable for people with AS, while golimumab lacks approval for CD [9]. Certolizumab pegol was approved by the U.S. Food and Drug Administration in 2008 to treat and help maintain control of moderate to severe CD in people who did not get enough benefit from standard treatments [ 9 , 10 ] . The study aimed to identify incidence and types of musculoskeletal symptoms associated with IBD; relation to IBD activity, lines of treatment used and efficacy of drugs in prevention and treatment of these joint manifestations. Methods This cross sectional study included 150 patients with IBD attending IBD Outpatient Clinics of Department of Internal Medicine of Al-Rajhi Liver Hospital at Assiut University were selected for a cross-sectional study. Any patient with one or more of the following criteria was excluded; Age > 65 or < 18 years’ old; Autoimmune disease like SLE, RA, psoriasis; Osteoarthritis or gouty arthritis; Malignancy; Polymyalgia rheumatica; Patient refusal. The study was conducted according to the principles of the Declaration of Helsinki (64th WMA General Assembly, Fortaleza, Brazil, October 2013) and was authorized by the Hospital’s Ethics Committee. Purpose of the study was given to all participants, and verbal informed permission was obtained. The study was explained to all patients and only patients who agreed participated in study. This study was registered on clinical trials.gov with identifier: IRB.no: 04-2023-200065. Demographic data including age, sex, special habits were collected. Patients were asked about symptoms of IBD, extraintestinal manifestations, family history. Diagnosis of disease activity and severity was graded according to TruLove classification Severity Index for UC, simple clinical colitis activity index and Mayo score for activity. In addition to history of any joint affection were recorded. Physical examination stressing on rheumatological examination of the affected joints either peripheral or axial. For inflammatory back pain (IBP) features and The ASAS (Assessment of Spondylarthritis international Society) score. Laboratory data: Included complete blood count (CBC), Liver function test, kidney function test, coagulation profile, serum electrolytes (NA, K), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Endoscopy and Radiology: Colonoscopy with ileal intubation with histopathology (to all patients at time of diagnosis) and upper endoscopy in symptomatic CD patients. Radiological evaluation of affected joints: After finishing the physical examination and completing the questionnaire during a face-to-face interview, patients were directed to a well-equipped imaging facility to do a pelvic and lumbosacral x-ray. The radiologist blinded to the rheumatologic exam results. SI grading was completed using the New York criterion [ 11 ] . Statistical analysis: The data analyzed by the Statistical Package for the Social Sciences, version 20.0 (SPSS Inc., Chicago, Illinois, USA). Quantitative data expressed as mean ± Standard Deviation (SD) as well as analyzed with the Student's T-test. Qualitative data were reported like frequency and percentage and analyzed using the Chi-squared test. Multivariate regression analysis was conducted to identify independent risk factors for musculoskeletal disorders in patients with IBD. A 95% confidence level was maintained, and a P value was considered statistically substantial if it was less than 0.05. Results It was found that patients with joint affection had significantly higher mean age compared to patients without joint affection (38.01 ± 7.22 vs. 33.19 ± 4.70 (years); p < 0.001). Majority of patients with joint affection were females (70%) and majority of patients without joint affection (60%) were males with substantial difference across groups (P < 0.001). There was no substantial difference across groups as regards mean body mass index (23.15 ± 2.45 vs. 24.01 ± 2.99 (kg/m2); P = 0.12) and residence. Table 1 Table 1 Demographic data of the studied groups Patients with joint affection (n = 50) Patients without joint affection (n = 100) P Age (years) 38.01 ± 7.22 33.19 ± 4.70 < 0.001* Sex Male 15(30%) 60(60%) < 0.001* Female 35(70%) 40(40%) Residence 0.59 Rural 40(80%) 90(90%) Urban 10(20%) 10(10%) BMI (kg/m 2 ) 23.15 ± 2.45 24.01 ± 2.99 0.12 Data expressed as frequency (percentage), mean (SD). P value was significant if < 0.05. BMI: Body Mass Index. Mean duration of the disease among the studied patients with joint affection was significantly longer than those without joint affection (4.60 ± 1.33 vs. 2.09 ± 1.09 (years); p < 0.001). Also, both groups of patients had significant differences as regards severity of the disease (p < 0.001). Mild, moderate and severe disease activity presents 18 (36%), 10 (20%) and 22 (44%) patients with joint affection. And present in 80 (80%), 15 (15%) and 5 (5%) patients without joint affection, respectively. Majority of both groups had UC (131 patient 87%). Type of IBD and different lines of therapy were comparable in both groups (P > 0.05). Table 2 Table 2 Diseases’ characteristics in studied patients with IBD Patients with joint affection (n = 50) Patients without joint affection (n = 100) P Duration of disease (year) 4.60 ± 1.33 2.09 ± 1.09 < 0.001* Type of IBD 0.45 UC 40(80%) 91(91%) CD 10(20%) 9(9%) Therapy 0.37 Amino salicylates 9(18%) 20(20%) Steroid 20(40%) 39(39%) Azathioprine 15(30%) 32(32%) Biological therapy 6(12%) 9(9%) Activity of the disease < 0.001* Mild 18(36%) 80(80%) Moderate 10(20%) 15(15%) Severe 22(44%) 5(5%) Data expressed as frequency (percentage), mean (SD). IBD: Inflammatory Bowel Disease, UC: Ulcerative Colitis, CD: Crohn’s Disease. Both groups had insubstantial differences as regard baseline laboratory data with exception of substantially higher CRP (45.55 ± 2.18 vs. 6.70 ± 1.22 (mg/dl); P < 0.001) and ESR (33.45 ± 4.09 vs. 7.76 ± 1.54 (ml/hr); P = 0.001) with lower serum albumin (31.45 ± 1.76 vs. 37.01 ± 4.31 (mg/dl); P = 0.01) among patients with joint affection. Table 3 Table 3 Baseline laboratory data in studied groups based on joint affection Patients with joint affection (n = 50) Patients without joint affection (n = 100) P HB (gm/dl) 11.01 ± 2.11 11.22 ± 1.07 0.87 Leucocytes (10 3 /ul) 8.33 ± 2.78 7.43 ± 2.78 0.10 Platelets (10 3 /ul) 187.12 ± 56.78 190.56 ± 33.89 0.64 Urea (mg/dl) 4.56 ± 2.39 7.08 ± 1.89 0.45 Creatinine (mmol/l) 99.91 ± 15.67 102.01 ± 5.98 0.11 Total proteins (mg/dl) 76.54 ± 9.11 79.09 ± 5.66 0.50 Albumin (mg/dl) 31.45 ± 1.76 37.01 ± 4.31 0.01* Alanine transaminase (u/L) 19.56 ± 2.90 20.90 ± 2.50 0.20 Aspartate transaminase (u/L) 22.11 ± 6.11 23.47 ± 4.09 0.90 Bilirubin (mmol/l) 10.48 ± 2.23 9.56 ± 2.11 0.32 ESR (ml/h) 33.45 ± 4.09 7.76 ± 1.54 0.001* CRP (mg/dl) 45.55 ± 2.18 6.70 ± 1.22 < 0.001* Sodium (mmol) 134.11 ± 0.30 133.19 ± 0.30 0.34 Potassium (mmol/l) 4.50 ± 0.12 4.46 ± 0.10 0.30 Data expressed as mean (SD). *:P value was significant if < 0.05. HB: Hemoglobin, CRP: C-Reactive Protein. ESR: Erythrocyte Sedimentation Rate. A total of 23 (46%) patients had axial affection, and 20 (40%) patients had peripheral affection. Meanwhile, 7 (14%) patients had both affections. Majority 12 (60%) of patients had less than five affected joints, and 8 (40%) patients had more than five joints affection. As regard peripheral symptoms, 3 (6%), 2 (4%), 1 (2%) and 1 (2%) patient had synovitis, dactylitis, planter fasciitis and enthesitis, respectively. At the same time, 43 (86%) patients had no peripheral symptoms. Figure 1 Regarding the other extraintestinal manifestations, it was found that both groups had insignificant differences as regard erythema nodosum (2% vs. 0), episcleritis (2% vs. 0), hepatomegaly (8% vs. 7%), vasculitis (2% vs. 2%) and renal stones (2% vs. 0). Figure 2 According to the present research, indicators of joint affection among patients with IBD were greater duration of the disease (OR = 3.01), female sex (OR = 2.98) and severe disease (OR = 5.66). Meanwhile, type of IBD (UC/CD) and type of therapy (conventional or biological) were not predictors for joint affection. Table 4 Table 4 Predictors of joints affection among the studied patients OR 95%CI P Old age (years) 1.22 0.76–2.44 0.09 Longer duration (years) 3.01 2.50–7.66 < 0.001* Female sex 2.98 1.45–4.01 0.01* Severe disease 5.66 4.55–11.50 < 0.001* Type of IBD 1.09 0.45–2.11 0.45 Type of therapy 0.98 0.22–1.87 0.31 P value was significant if < 0.05. OR: odd’s Ratio; CI: Confidence Interval; IBD: Inflammatory Bowel Disease. Discussion The present trial involved an overall of 150 participants with IBD. A total of 50/150 (33.3%) patients had joint affection, and 100/150 (66.7%) patients had no joint affection. This frequency of joint affection in our study was comparable with previous reports with prevalence between 2–46% [ 12 ] . In cross-sectional research on 96 mild-to-moderate IBD patients, the authors found that 33 cases (34.4%) had joint affection [ 5 ] . Our research showed that people who experienced joint affection had significantly higher mean age than patients without joint affection (38.01 ± 7.22 vs. 33.19 ± 4.70 (years); P < 0.001). Majority of patients with joint affection were females (70%) and majority of patients without joint affection (60%) were males with substantial difference among both groups (P < 0.001). In line with the current study, Yamamoto-Furusho JK et al. [ 13 ] stated that majority of patients with joint affection were females (61.68%) and majority of patients without joint affection were males (56.73%). Yet, both groups were comparable as regards the age (31.97 vs. 31.82; P = 0.60). Another finding in the present study was that mean duration of the disease among the studied patients with joint affection was significantly longer than those without joint affection (4.60 ± 1.33 vs. 2.09 ± 1.09 (years); P < 0.001). Also, both groups of patients had significant differences as regards severity of the disease where most patients with joint affection had severe disease (P < 0.001). In contrast with Salvarani et al. [ 14 ] Research indicated that nearly 60% of individuals presenting extraintestinal symptoms with severe colitis on histological examination. Furthermore, an association was established between arthralgias and disease extent, with the highest prevalence observed in individuals with extensive colitis (39.8%), followed by left colitis (35.1%) and distal colitis (19%) [ 15 ] . In our study, it was shown that joint affection presence is closely connected to activity and severity of UC by Truelove and Witts criterion [ 13 ] . Similar findings have been found in other studies, such as the one conducted by De Vos et al . [ 16 ] , where 37% of the patients showed more severe disease activity or relapse of UC related with these features existence. Also in the present study, we found that both groups(with joint affection & without joint affection) had insignificant differences as regard baseline laboratory data with exception of significantly higher CRP (45.55 ± 2.18 vs. 6.70 ± 1.22 (mg/dl); P < 0.001) and ESR (33.45 ± 4.09 vs. 7.76 ± 1.54 (ml/hr.); P = 0.001) with lower serum albumin (31.45 ± 1.76 vs. 37.01 ± 4.31 (mg/dl); P = 0.01) among patients with joint affection. Similarly, previous study found that from the patients with joint affection, 19 (12.33%) presented with anemia, 6 (3.89%) reported low albumin levels, 90 (58.44%) presented increased CRP, and 97 (62.98%) provided elevated ESR [ 13 ] . In this study a total of 23 (46%) patients had axial affection, and 20 (40%) patients had peripheral affection. Meanwhile, 7 (14%) patients had both affections. Majority 12 (60%) of patients had less than five affected joints, and 8 (40%) patients had more than five joints affection. As regards peripheral symptoms, 3 (6%), 2 (4%), 1 (2%) and 1 (2%) patient had synovitis, dactylitis, and enthesitis, respectively. At the same time, 43 (86%) patients had no peripheral symptoms. In a recent study, a total of 57 (46%), 45 (36.3%) and 22 (17.7%) patients had axial, peripheral and mixed affection, respectively. Also, (6/102), (27/102) and (69/102) patients from those with peripheral affection had mono-, oligo- and polyarthritis [ 17 ] . Based on our study; predictors of joint affection among patients with IBD were longer duration of the disease (OR = 3.01), female sex (OR = 2.98) and severe disease (OR = 5.66). Meanwhile, type of IBD (UC/CD) and type of therapy (conventional or biological) were not predictors for joint affection. In agreement with such findings, a history of EIMs, being older, and being female are all associated with an increased risk of developing more EIMs involving musculoskeletal symptoms as reported in many previous studies [ 18 ] . Genetic variables and the microbiome composition of IBD patients may influence musculoskeletal symptoms. Consequently, the possible influence of genetics on the manifestation of extraintestinal symptoms in patients warrant consideration. Additional research is required to examine these aspects [ 5 , 19 ] . Our study has some limits including being executed in a singular center with a limited sample size. All radiological findings were examined just by radiograph without more advanced imaging as CT and MRI. Also, we didn’t analyze quality of life among those patients. In addition, In order to better understand which musculoskeletal symptoms are linked to inflammatory bowel disease (IBD) or, more generally, immune driven inflammatory illnesses, future research should compare our data with general population musculoskeletal complaints. Based on the current investigation, it’s recommended to perform such investigations across various centers with patients’ large number, follow those patients for longer duration to assess effect of joints affection on their quality of life and effect of different lines of therapy on joint affection and more assessment of patients with suspected joint affection with CT/MRI. Conclusion Joint manifestations are considered relatively prevalent in individuals with inflammatory bowel illness (33.3%). Patients with longer duration of the disease, female gender and more severe disease were more liable to develop joint affection. We found that type of IBD and its lines of therapy had no correlation with occurrence of joint manifestations. Abbreviations GI Gastrointestinal Tract IBD Inflammatory Bowel Disease UC Ulcerative Colitis CD Crohn’s Disease EIMs Extra-Intestinal Manifestations MSK Musculoskeletal System SpA Spondyloarthropathy AS Ankylosing Spondylitis PsA Psoriatic Arthritis ReA Reactive Arthritis SI Sacroiliitis NSAIDs Nonsteroidal Anti-Inflammatory Medicines TNFα Anti-Tumor Necrosis Factor Alpha IBP Inflammatory Back Pain CBC complete blood count ESR Erythrocyte Sedimentation Rate CRP C-Reactive Protein Declarations Finding: Nil. Author Contribution All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [G.H.A.], [N.M.T.], [M.A.A.A.] and [H.F.]. The first draft of the manuscript was written by [Y.Y.S] and all authors commented on previous versions of the manuscript. 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Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 23 Mar, 2026 Reviews received at journal 09 Mar, 2026 Reviewers agreed at journal 02 Mar, 2026 Reviews received at journal 20 Feb, 2026 Reviewers agreed at journal 17 Feb, 2026 Reviewers invited by journal 16 Feb, 2026 Editor assigned by journal 22 Jan, 2026 Submission checks completed at journal 22 Jan, 2026 First submitted to journal 03 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8507984","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":594684320,"identity":"de30d8aa-f285-46fc-acd8-a0b66b35dac2","order_by":0,"name":"Ghada H. Ahmed","email":"","orcid":"","institution":"Assiut University","correspondingAuthor":false,"prefix":"","firstName":"Ghada","middleName":"H.","lastName":"Ahmed","suffix":""},{"id":594684321,"identity":"628e0ec3-cdf0-428f-9dc5-9b870d571921","order_by":1,"name":"Nabwia M. Tawfik","email":"","orcid":"","institution":"Assiut University","correspondingAuthor":false,"prefix":"","firstName":"Nabwia","middleName":"M.","lastName":"Tawfik","suffix":""},{"id":594684324,"identity":"f7f26663-833c-46e6-bf50-58b422bad441","order_by":2,"name":"Mohamed A. A. Abozaid","email":"","orcid":"","institution":"Assiut University","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"A. A.","lastName":"Abozaid","suffix":""},{"id":594684326,"identity":"a53a9c27-4356-4306-bd40-ff72aac0dca3","order_by":3,"name":"Youstina Y. Soliman","email":"data:image/png;base64,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","orcid":"","institution":"Assiut University","correspondingAuthor":true,"prefix":"","firstName":"Youstina","middleName":"Y.","lastName":"Soliman","suffix":""},{"id":594684328,"identity":"aad2fcc2-f498-45ba-b40e-bfb2030f9b27","order_by":4,"name":"Hayam Fathy","email":"","orcid":"","institution":"Assiut University","correspondingAuthor":false,"prefix":"","firstName":"Hayam","middleName":"","lastName":"Fathy","suffix":""}],"badges":[],"createdAt":"2026-01-03 15:53:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8507984/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8507984/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103258852,"identity":"26d8d93f-f97a-42be-aafc-c6456af4b9e9","added_by":"auto","created_at":"2026-02-23 17:34:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":370980,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Types of joint affection among patients with joint affection and (B) peripheral symptoms among patients with joint affection\u003c/p\u003e","description":"","filename":"OnlineFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8507984/v1/f5f4b88613ec6ad44221c5eb.png"},{"id":103258853,"identity":"f258adb4-cf9c-4592-9ba7-bcea02dcb6b6","added_by":"auto","created_at":"2026-02-23 17:34:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":147538,"visible":true,"origin":"","legend":"\u003cp\u003eOther extraintestinal manifestations based on joint affection\u003c/p\u003e","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8507984/v1/222e7fdcd5945e9f8f226cad.png"},{"id":103258869,"identity":"280a1687-1953-421b-b0f3-db9c35cd12d0","added_by":"auto","created_at":"2026-02-23 17:34:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1741640,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8507984/v1/b1575888-bc93-4d79-bff4-8824054e0a56.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Inflammatory Bowel Disease Related Joint Manifestations: Incidence, Types, Relation to Disease Activity and Types of Treatment","fulltext":[{"header":"Background","content":"\u003cp\u003eOne chronic inflammatory disorder that affects the digestive tract is inflammatory bowel disease (IBD). As a group, Crohn's disease (CD) and ulcerative colitis (UC) are the two most common forms. Now, it is clear that IBD can also cause problems outside of the digestive tract. These are called extra-intestinal manifestations (EIMs), and they can affect the joints, eyes, skin, lungs, bile system, and blood \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. A key part of the problem in IBD is when the immune system reacts abnormally to bacteria in the gut and/or what these bacteria produce. Studies have shown links between gut bacteria, certain genes a person may have, and how sick someone ends up being \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The natural progression of the disease is marked by cycles of recurrence and remission, driven by several factors such as genetic predisposition, environmental conditions, and lifestyle choices, among others. A subgroup of seronegative SpA, along with ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), and undifferentiated SpA, was previously thought to include arthropathy linked with inflammatory bowel disease (IBD) \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Musculoskeletal manifestations specifically include the peripheral arthropathy by its both types pauciarticular and involves multiple joints and affect the spine, including sacroiliitis (SI), which might also involve inflammation of the vertebrae, similar to idiopathic AS \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eArthritis is joint involvement predominant kind in IBD patients, affecting roughly 30% of individuals, but SI and AS are less frequently detected, occurring in about 3.1% and 1.1% of people, respectively \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Although the incidence of SpA does not differ significantly between UC and CD, it appears to be more common in ulcerative pancolitis and chronic intermittent or continuous symptoms in UC patients. Common extraintestinal symptoms that accompany peripheral arthritis include erythema nodosum and anterior uveitis \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. The rheumatological manifestation could be a cause to change the line of management which is positioning of biological treatment. The treatment can be either conventional or biological. The therapy objectives for musculoskeletal manifestations of IBD are to diminish inflammation and to avert impairment or deformity. Nonsteroidal anti-inflammatory medicines (NSAIDs) are typically recommended to manage peripheral arthritis, back pain, and stiffness.Sulfasalazine, azathioprine, 6-mercaptopurine, methotrexate, as well as glucocorticoids may be beneficial for inflammation of both the gut and joints. Intraarticular glucocorticoid injections may be utilized for exacerbation of peripheral arthritis. However, amino salicylates (e.g. mesalamine), beneficial for regulating intestinal inflammation, appear to have no direct anti-inflammatory action on the synovium .Anti-TNF monoclonal antibodies (infliximab, adalimumab) are effective in IBD notably CD, and are beneficial for individuals with axial involvement and peripheral arthritis \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Patients with IBD and genuine AS who have an insufficient response to standard therapy are eligible for anti-tumor necrosis factor alpha (TNFα) medication. Infliximab, adalimumab, etanercept, and golimumab (human monoclonal antibody, 50 mg administered subcutaneously once monthly) are applicable for people with AS, while golimumab lacks approval for CD [9]. Certolizumab pegol was approved by the U.S. Food and Drug Administration in 2008 to treat and help maintain control of moderate to severe CD in people who did not get enough benefit from standard treatments \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe study aimed to identify incidence and types of musculoskeletal symptoms associated with IBD; relation to IBD activity, lines of treatment used and efficacy of drugs in prevention and treatment of these joint manifestations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross sectional study included 150 patients with IBD attending IBD Outpatient Clinics of Department of Internal Medicine of Al-Rajhi Liver Hospital at Assiut University were selected for a cross-sectional study. Any patient with one or more of the following criteria was excluded; Age\u0026thinsp;\u0026gt;\u0026thinsp;65 or \u0026lt;\u0026thinsp;18 years\u0026rsquo; old; Autoimmune disease like SLE, RA, psoriasis; Osteoarthritis or gouty arthritis; Malignancy; Polymyalgia rheumatica; Patient refusal. The study was conducted according to the principles of the Declaration of Helsinki (64th WMA General Assembly, Fortaleza, Brazil, October 2013) and was authorized by the Hospital\u0026rsquo;s Ethics Committee. Purpose of the study was given to all participants, and verbal informed permission was obtained. The study was explained to all patients and only patients who agreed participated in study. This study was registered on clinical trials.gov with identifier: IRB.no: 04-2023-200065.\u003c/p\u003e \u003cp\u003eDemographic data including age, sex, special habits were collected. Patients were asked about symptoms of IBD, extraintestinal manifestations, family history.\u003c/p\u003e \u003cp\u003eDiagnosis of disease activity and severity was graded according to TruLove classification Severity Index for UC, simple clinical colitis activity index and Mayo score for activity.\u003c/p\u003e \u003cp\u003eIn addition to history of any joint affection were recorded. Physical examination stressing on rheumatological examination of the affected joints either peripheral or axial. For inflammatory back pain (IBP) features and The ASAS (Assessment of Spondylarthritis international Society) score.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eLaboratory data:\u003c/h2\u003e \u003cp\u003eIncluded complete blood count (CBC), Liver function test, kidney function test, coagulation profile, serum electrolytes (NA, K), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEndoscopy and Radiology:\u003c/h3\u003e\n\u003cp\u003eColonoscopy with ileal intubation with histopathology (to all patients at time of diagnosis) and upper endoscopy in symptomatic CD patients.\u003c/p\u003e \u003cp\u003eRadiological evaluation of affected joints: After finishing the physical examination and completing the questionnaire during a face-to-face interview, patients were directed to a well-equipped imaging facility to do a pelvic and lumbosacral x-ray. The radiologist blinded to the rheumatologic exam results. SI grading was completed using the New York criterion \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eThe data analyzed by the Statistical Package for the Social Sciences, version 20.0 (SPSS Inc., Chicago, Illinois, USA). Quantitative data expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation (SD) as well as analyzed with the Student's T-test. Qualitative data were reported like frequency and percentage and analyzed using the Chi-squared test. Multivariate regression analysis was conducted to identify independent risk factors for musculoskeletal disorders in patients with IBD. A 95% confidence level was maintained, and a P value was considered statistically substantial if it was less than 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIt was found that patients with joint affection had significantly higher mean age compared to patients without joint affection (38.01\u0026thinsp;\u0026plusmn;\u0026thinsp;7.22 vs. 33.19\u0026thinsp;\u0026plusmn;\u0026thinsp;4.70 (years); p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Majority of patients with joint affection were females (70%) and majority of patients without joint affection (60%) were males with substantial difference across groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There was no substantial difference across groups as regards mean body mass index (23.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45 vs. 24.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99 (kg/m2); P\u0026thinsp;=\u0026thinsp;0.12) and residence. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data of the studied groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients with joint affection (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients without joint affection (n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.01\u0026thinsp;\u0026plusmn;\u0026thinsp;7.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.19\u0026thinsp;\u0026plusmn;\u0026thinsp;4.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35(70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40(80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90(90%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eData expressed as frequency (percentage), mean (SD). P value was significant if\u0026thinsp;\u0026lt;\u0026thinsp;0.05. BMI: Body Mass Index.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMean duration of the disease among the studied patients with joint affection was significantly longer than those without joint affection (4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33 vs. 2.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09 (years); p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Also, both groups of patients had significant differences as regards severity of the disease (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Mild, moderate and severe disease activity presents 18 (36%), 10 (20%) and 22 (44%) patients with joint affection. And present in 80 (80%), 15 (15%) and 5 (5%) patients without joint affection, respectively. Majority of both groups had UC (131 patient 87%). Type of IBD and different lines of therapy were comparable in both groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDiseases\u0026rsquo; characteristics in studied patients with IBD\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients with joint affection (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients without joint affection (n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of disease (year)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of IBD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40(80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91(91%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTherapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAmino salicylates\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSteroid\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(39%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAzathioprine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBiological therapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eActivity of the disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMild\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80(80%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22(44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eData expressed as frequency (percentage), mean (SD). IBD: Inflammatory Bowel Disease, UC: Ulcerative Colitis, CD: Crohn\u0026rsquo;s Disease.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBoth groups had insubstantial differences as regard baseline laboratory data with exception of substantially higher CRP (45.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18 vs. 6.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22 (mg/dl); P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and ESR (33.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.09 vs. 7.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54 (ml/hr); P\u0026thinsp;=\u0026thinsp;0.001) with lower serum albumin (31.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76 vs. 37.01\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31 (mg/dl); P\u0026thinsp;=\u0026thinsp;0.01) among patients with joint affection. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline laboratory data in studied groups based on joint affection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients with joint affection\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients without joint affection\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHB (gm/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeucocytes (10\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/ul)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlatelets (10\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/ul)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e187.12\u0026thinsp;\u0026plusmn;\u0026thinsp;56.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e190.56\u0026thinsp;\u0026plusmn;\u0026thinsp;33.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUrea (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCreatinine (mmol/l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e99.91\u0026thinsp;\u0026plusmn;\u0026thinsp;15.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e102.01\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal proteins (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e76.54\u0026thinsp;\u0026plusmn;\u0026thinsp;9.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e79.09\u0026thinsp;\u0026plusmn;\u0026thinsp;5.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlbumin (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e31.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e37.01\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlanine transaminase (u/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e19.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e20.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAspartate transaminase (u/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e22.11\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBilirubin (mmol/l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eESR (ml/h)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e33.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCRP (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e45.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSodium (mmol)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e134.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e133.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePotassium (mmol/l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eData expressed as mean (SD). *:P value was significant if\u0026thinsp;\u0026lt;\u0026thinsp;0.05. HB: Hemoglobin, CRP: C-Reactive Protein. ESR: Erythrocyte Sedimentation Rate.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA total of 23 (46%) patients had axial affection, and 20 (40%) patients had peripheral affection. Meanwhile, 7 (14%) patients had both affections. Majority 12 (60%) of patients had less than five affected joints, and 8 (40%) patients had more than five joints affection. As regard peripheral symptoms, 3 (6%), 2 (4%), 1 (2%) and 1 (2%) patient had synovitis, dactylitis, planter fasciitis and enthesitis, respectively. At the same time, 43 (86%) patients had no peripheral symptoms. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding the other extraintestinal manifestations, it was found that both groups had insignificant differences as regard erythema nodosum (2% vs. 0), episcleritis (2% vs. 0), hepatomegaly (8% vs. 7%), vasculitis (2% vs. 2%) and renal stones (2% vs. 0). Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAccording to the present research, indicators of joint affection among patients with IBD were greater duration of the disease (OR\u0026thinsp;=\u0026thinsp;3.01), female sex (OR\u0026thinsp;=\u0026thinsp;2.98) and severe disease (OR\u0026thinsp;=\u0026thinsp;5.66). Meanwhile, type of IBD (UC/CD) and type of therapy (conventional or biological) were not predictors for joint affection. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of joints affection among the studied patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOld age (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.76\u0026ndash;2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLonger duration (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.50\u0026ndash;7.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale sex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.45\u0026ndash;4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSevere disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.55\u0026ndash;11.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of IBD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.45\u0026ndash;2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of therapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.22\u0026ndash;1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eP value was significant if\u0026thinsp;\u0026lt;\u0026thinsp;0.05. OR: odd\u0026rsquo;s Ratio; CI: Confidence Interval; IBD: Inflammatory Bowel Disease.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present trial involved an overall of 150 participants with IBD. A total of 50/150 (33.3%) patients had joint affection, and 100/150 (66.7%) patients had no joint affection. This frequency of joint affection in our study was comparable with previous reports with prevalence between 2\u0026ndash;46% \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. In cross-sectional research on 96 mild-to-moderate IBD patients, the authors found that 33 cases (34.4%) had joint affection \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur research showed that people who experienced joint affection had significantly higher mean age than patients without joint affection (38.01\u0026thinsp;\u0026plusmn;\u0026thinsp;7.22 vs. 33.19\u0026thinsp;\u0026plusmn;\u0026thinsp;4.70 (years); P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Majority of patients with joint affection were females (70%) and majority of patients without joint affection (60%) were males with substantial difference among both groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eIn line with the current study, Yamamoto-Furusho JK et al. \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e stated that majority of patients with joint affection were females (61.68%) and majority of patients without joint affection were males (56.73%). Yet, both groups were comparable as regards the age (31.97 vs. 31.82; P\u0026thinsp;=\u0026thinsp;0.60).\u003c/p\u003e \u003cp\u003eAnother finding in the present study was that mean duration of the disease among the studied patients with joint affection was significantly longer than those without joint affection (4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33 vs. 2.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09 (years); P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Also, both groups of patients had significant differences as regards severity of the disease where most patients with joint affection had severe disease (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eIn contrast with Salvarani et al. \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e Research indicated that nearly 60% of individuals presenting extraintestinal symptoms with severe colitis on histological examination. Furthermore, an association was established between arthralgias and disease extent, with the highest prevalence observed in individuals with extensive colitis (39.8%), followed by left colitis (35.1%) and distal colitis (19%) \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study, it was shown that joint affection presence is closely connected to activity and severity of UC by Truelove and Witts criterion \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSimilar findings have been found in other studies, such as the one conducted by De Vos et al .\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, where 37% of the patients showed more severe disease activity or relapse of UC related with these features existence. Also in the present study, we found that both groups(with joint affection \u0026amp; without joint affection) had insignificant differences as regard baseline laboratory data with exception of significantly higher CRP (45.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18 vs. 6.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22 (mg/dl); P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and ESR (33.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.09 vs. 7.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54 (ml/hr.); P\u0026thinsp;=\u0026thinsp;0.001) with lower serum albumin (31.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76 vs. 37.01\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31 (mg/dl); P\u0026thinsp;=\u0026thinsp;0.01) among patients with joint affection.\u003c/p\u003e \u003cp\u003eSimilarly, previous study found that from the patients with joint affection, 19 (12.33%) presented with anemia, 6 (3.89%) reported low albumin levels, 90 (58.44%) presented increased CRP, and 97 (62.98%) provided elevated ESR \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study a total of 23 (46%) patients had axial affection, and 20 (40%) patients had peripheral affection. Meanwhile, 7 (14%) patients had both affections. Majority 12 (60%) of patients had less than five affected joints, and 8 (40%) patients had more than five joints affection. As regards peripheral symptoms, 3 (6%), 2 (4%), 1 (2%) and 1 (2%) patient had synovitis, dactylitis, and enthesitis, respectively. At the same time, 43 (86%) patients had no peripheral symptoms.\u003c/p\u003e \u003cp\u003eIn a recent study, a total of 57 (46%), 45 (36.3%) and 22 (17.7%) patients had axial, peripheral and mixed affection, respectively. Also, (6/102), (27/102) and (69/102) patients from those with peripheral affection had mono-, oligo- and polyarthritis \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBased on our study; predictors of joint affection among patients with IBD were longer duration of the disease (OR\u0026thinsp;=\u0026thinsp;3.01), female sex (OR\u0026thinsp;=\u0026thinsp;2.98) and severe disease (OR\u0026thinsp;=\u0026thinsp;5.66). Meanwhile, type of IBD (UC/CD) and type of therapy (conventional or biological) were not predictors for joint affection.\u003c/p\u003e \u003cp\u003eIn agreement with such findings, a history of EIMs, being older, and being female are all associated with an increased risk of developing more EIMs involving musculoskeletal symptoms as reported in many previous studies \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGenetic variables and the microbiome composition of IBD patients may influence musculoskeletal symptoms. Consequently, the possible influence of genetics on the manifestation of extraintestinal symptoms in patients warrant consideration. Additional research is required to examine these aspects \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur study has some limits including being executed in a singular center with a limited sample size. All radiological findings were examined just by radiograph without more advanced imaging as CT and MRI. Also, we didn\u0026rsquo;t analyze quality of life among those patients. In addition, In order to better understand which musculoskeletal symptoms are linked to inflammatory bowel disease (IBD) or, more generally, immune driven inflammatory illnesses, future research should compare our data with general population musculoskeletal complaints.\u003c/p\u003e \u003cp\u003eBased on the current investigation, it\u0026rsquo;s recommended to perform such investigations across various centers with patients\u0026rsquo; large number, follow those patients for longer duration to assess effect of joints affection on their quality of life and effect of different lines of therapy on joint affection and more assessment of patients with suspected joint affection with CT/MRI.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eJoint manifestations are considered relatively prevalent in individuals with inflammatory bowel illness (33.3%). Patients with longer duration of the disease, female gender and more severe disease were more liable to develop joint affection. We found that type of IBD and its lines of therapy had no correlation with occurrence of joint manifestations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGastrointestinal Tract\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIBD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInflammatory Bowel Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUlcerative Colitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCrohn\u0026rsquo;s Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eEIMs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExtra-Intestinal Manifestations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMSK\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMusculoskeletal System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSpA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSpondyloarthropathy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnkylosing Spondylitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePsA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePsoriatic Arthritis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eReA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReactive Arthritis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSacroiliitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNSAIDs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNonsteroidal Anti-Inflammatory Medicines\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eTNFα\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnti-Tumor Necrosis Factor Alpha\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIBP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInflammatory Back Pain\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCBC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecomplete blood count\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eESR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eErythrocyte Sedimentation Rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCRP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eC-Reactive Protein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eFinding:\u003c/h2\u003e \u003cp\u003eNil.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [G.H.A.], [N.M.T.], [M.A.A.A.] and [H.F.]. The first draft of the manuscript was written by [Y.Y.S] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eNil\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMisteg\u0026aring;rd J, Gudbjornsson B, Lindqvist U, Laasonen L, Ejstrup L, St\u0026aring;hle M et al (2021) Comorbidities in a Cohort of 66 Patients With Psoriatic Arthritis Mutilans\u0026mdash;Results From the Nordic PAM Study. 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Clin Rheumatol 35:281\u0026ndash;289. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/https://doi.org/10.1007/s10067-015-3074-z\u003c/span\u003e\u003cspan address=\"10.1007/s10067-015-3074-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-internal-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Internal Medicine](https://ejim.springeropen.com/)","snPcode":"43162","submissionUrl":"https://submission.springernature.com/new-submission/43162/3","title":"The Egyptian Journal of Internal Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Inflammatory Bowel Disease, Crohn’s Disease, Ulcerative Colitis, Musculoskeletal, Joint","lastPublishedDoi":"10.21203/rs.3.rs-8507984/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8507984/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTwo chronic gastrointestinal disorders that make up inflammatory bowel disease (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The disease has extraintestinal affection including articular which is the most common, ocular, dermatologic, pulmonary, biliary and haemtologic.\u003c/p\u003e\u003ch2\u003ePurpose of the study:\u003c/h2\u003e \u003cp\u003eThe study aimed to identify incidence and types of musculoskeletal symptoms associated with IBD; relation to IBD activity, lines of treatment used and efficacy of drugs in prevention and treatment of these joint manifestations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional hospital-based study conducted on 150 patients diagnosed with IBD based on clinical, laboratory, radiological, endoscopic and histopathological data. Detailed history, examination and complete investigations including colonoscopy, histopathology, pelvic and lumbosacral x-ray were performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 150 patients were included, 131 patients had UC, 19 patients had CD, 50 (33.3%) patients had joint affection, and 100 (66.7%) patients didn't have joint affection. A total of 23 (46%) patients had axial affection, and 20 (40%) patients had peripheral affection. Meanwhile, 7 (14%) patients had both affections. Majority (60%) of patients had less than five affected joints, and 20 (40%) patients had more than five joints affection. At the same time, 43 (86%) patients had no peripheral symptoms.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eJoint manifestations fairly common in patients with IBD (33.3%). Patients with longer duration of the disease, female gender and more active severe disease were more liable to develop joint affection. Type of IBD, either CD or UC, and its lines of therapy had no correlation with occurrence of joint manifestations.\u003c/p\u003e","manuscriptTitle":"Inflammatory Bowel Disease Related Joint Manifestations: Incidence, Types, Relation to Disease Activity and Types of Treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-23 17:34:03","doi":"10.21203/rs.3.rs-8507984/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-24T00:28:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T19:57:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"219333492749319047558478483177522186269","date":"2026-03-02T08:20:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-20T23:18:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301649956741826418716088828702863383331","date":"2026-02-17T18:32:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-16T22:55:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-22T18:24:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-22T06:07:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Journal of Internal Medicine","date":"2026-01-03T15:40:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-internal-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Internal Medicine](https://ejim.springeropen.com/)","snPcode":"43162","submissionUrl":"https://submission.springernature.com/new-submission/43162/3","title":"The Egyptian Journal of Internal Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"faa13214-dc30-402f-8ac6-db577c40a36b","owner":[],"postedDate":"February 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T10:24:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-23 17:34:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8507984","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8507984","identity":"rs-8507984","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}