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Objective: There is an increasing emphasis on the early identification and treatment of ankylosing spondylitis (AS) of which the hallmark is sacroiliitis. Patients with inflammatory bowel disease (IBD) are at increased risk of AS and often receive computed tomography (CT) scans of their abdomen, affording clinicians the opportunity to determine the presence of sacroiliitis. Previous studies using CT have relied only on the radiologist's gestalt or a nonvalidated adaptation of the modified New York criteria. Our aim is to assess the prevalence of sacroiliitis in IBD using a validated screening tool and to determine how frequently these patients are referred for rheumatologic evaluation.Methods: Patients with IBD were recruited from an IBD clinic. Control patients were recruited from a urology clinic and were confirmed to be without back pain, spondylitis, psoriasis, colitis, or uveitis by chart review. CT scans were read by 2 blinded readers and sacroiliitis was defined by the presence of ankylosis or a total erosion score of ≥3.Results: CT scans were available in 233 Crohn's disease (CD) patients, 83 ulcerative colitis (UC) patients, and 108 control patients, and sacroiliitis was seen in 15%, 16.9%, and 5.6% of patients, respectively. The prevalence was higher in patients with IBD than in controls (P = 0.007), with no significant difference between CD and UC patients. Of the 49 IBD patients found to have sacroiliitis by CT scan, only 5 had been referred to a rheumatologist.Conclusion: There is a 3-fold higher prevalence of sacroiliitis in IBD compared with controls. Despite a growing awareness of this increased prevalence, many patients are not referred to a rheumatologist. [ABSTRACT FROM AUTHOR]

Osteopenia and osteoporosis are prevalent in patients with Crohn's disease (CD). We conducted a cross-sectional study on consecutive patients with CD to assess the prevalence and factors associated with low bone mass density (BMD). One hundred sixty-eight patients with CD were evaluated. Baseline demographics, medical and surgical history, calcium intake, physical activity, steroid use, Harvey Bradshaw Index, blood and urine tests, and dual-energy X-ray absorptiometry were obtained. Sixty-seven (40%) and seventy-five (45%) patients had osteopenia of the femur and spine, respectively. Ten to 11% of patients had osteoporosis. Of the 40 patients who never used steroids, 19 (48%) had osteopenia of the femur and 12 (30%) of the spine. Significant associations were found between BMD and age, body mass index, and serum magnesium. Lifetime steroid use was a weaker predictor of bone loss. Duration of disease did not correlate with BMD when adjusted for age. At follow-up at a mean of 2 years, BMD declined in the femur but not the spine. However, those with ongoing steroid use had lower spine BMD. A significant number of patients with CD have osteopenia. Age was the most important predictor of bone loss. Significant proportion of steroid naive patients had osteopenia, which implies that mechanisms other than steroid use are also involved in bone loss in CD. Disease activity, systemic inflammation, and hormonal and genetic factors may all be important determinants of bone loss in CD.