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Are inflammatory bowel disease patients aware of Achilles tendonitis?
CROHNS-00909; No of Pages 1 Journal of Crohn's and Colitis (2013) xx, xxx Available online at www.sciencedirect.com
ScienceDirect
LETTER TO THE EDITOR Are inflammatory bowel disease patients aware of Achilles tendonitis?
tendonitis and IBD is often overlooked. Therefore, both IBD patients and physicians should be aware of tendonitis findings. Conflict of Interest
Dear Sir,
We read with great interest the article by Huang and colleagues who found that most inflammatory bowel disease (IBD) patients were aware of arthritis.1 The most common extra intestinal manifestation involves the musculoskeletal system in inflammatory bowel diseases (IBD). Axial, peripheral arthritis and Ankylosing Spondylitis (AS) occur in approximately one third of patients with IBD.2 The authors found that approximately 70% of patients were aware of the risk of arthritis. This frequency is very significant. Thus, we think that rheumatologists should pay attention to possible musculoskeletal findings. However, many physiciaans may overlooked the relationship between IBD and Achille' s tendonitis. A 20-year-old male patient was admitted to our department, physical medicine and rehabilitation clinic, complaining of bilateral back of heel pain and swelling. Physical examination detected warmth and tenderness on the Achilles tendon and at its calcaneal insertion and also tenderness to palpation of the posterior iliac crest. Colonoscopy was performed because he also had a history of diarrhea. Aphthous ulcers in the terminal ileum were demonstrated. Biopsy revealed lymphoplasmacytic inflammation. The patient was diagnosed with Crohn's disease and budesonide (9 mg/day) was initialed. After treatment, symptoms of enthesitis completely subsided within 72 h. Although the most frequent clinical expression of enthesitis is Achilles tendonitis, it may be a very rare initial presentation of IBD. Achilles tendonitis patients are often referred to rheumatology clinics, but the relationship between Achilles
No commercial party having a direct financial support or any conflict interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
References 1. Huang V, Mishra R, Thanabalan R, Nguyen GC. Patient awareness of extraintestinal manifestations of inflammatory bowel disease. J Crohns Colitis 2013;7:e318–24. 2. Brakenhoff LK, van der Heijde DM, Hommes DW, Huizinga TW, Fidder HH. The joint–gut axis in inflammatory bowel diseases. J Crohns Colitis 2010;4:257–68.
Ayla Akbal* Ferhat Gökmen Davut Döner Fatma Uysal Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart University, Çanakkale, Turkey ⁎ Correspondence address: Çanakkale Onsekiz Mart University, Faculty of Medicine, 17100, Çanakkale, Turkey, Tel: +90 286 2180018, Fax:+ 90286 263 59 56.1 650 721 1742. E-mail address: [email protected] (A. Akbal). 7 December 2013
1873-9946/$ - see front matter © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.crohns.2013.12.004 Please cite this article as: Akbal A, et al, Are inflammatory bowel disease patients aware of Achilles tendonitis?, J Crohns Colitis (2013), http:// dx.doi.org/10.1016/j.crohns.2013.12.004
ScienceDirect
LETTER TO THE EDITOR Are inflammatory bowel disease patients aware of Achilles tendonitis?
tendonitis and IBD is often overlooked. Therefore, both IBD patients and physicians should be aware of tendonitis findings. Conflict of Interest
Dear Sir,
We read with great interest the article by Huang and colleagues who found that most inflammatory bowel disease (IBD) patients were aware of arthritis.1 The most common extra intestinal manifestation involves the musculoskeletal system in inflammatory bowel diseases (IBD). Axial, peripheral arthritis and Ankylosing Spondylitis (AS) occur in approximately one third of patients with IBD.2 The authors found that approximately 70% of patients were aware of the risk of arthritis. This frequency is very significant. Thus, we think that rheumatologists should pay attention to possible musculoskeletal findings. However, many physiciaans may overlooked the relationship between IBD and Achille' s tendonitis. A 20-year-old male patient was admitted to our department, physical medicine and rehabilitation clinic, complaining of bilateral back of heel pain and swelling. Physical examination detected warmth and tenderness on the Achilles tendon and at its calcaneal insertion and also tenderness to palpation of the posterior iliac crest. Colonoscopy was performed because he also had a history of diarrhea. Aphthous ulcers in the terminal ileum were demonstrated. Biopsy revealed lymphoplasmacytic inflammation. The patient was diagnosed with Crohn's disease and budesonide (9 mg/day) was initialed. After treatment, symptoms of enthesitis completely subsided within 72 h. Although the most frequent clinical expression of enthesitis is Achilles tendonitis, it may be a very rare initial presentation of IBD. Achilles tendonitis patients are often referred to rheumatology clinics, but the relationship between Achilles
No commercial party having a direct financial support or any conflict interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
References 1. Huang V, Mishra R, Thanabalan R, Nguyen GC. Patient awareness of extraintestinal manifestations of inflammatory bowel disease. J Crohns Colitis 2013;7:e318–24. 2. Brakenhoff LK, van der Heijde DM, Hommes DW, Huizinga TW, Fidder HH. The joint–gut axis in inflammatory bowel diseases. J Crohns Colitis 2010;4:257–68.
Ayla Akbal* Ferhat Gökmen Davut Döner Fatma Uysal Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart University, Çanakkale, Turkey ⁎ Correspondence address: Çanakkale Onsekiz Mart University, Faculty of Medicine, 17100, Çanakkale, Turkey, Tel: +90 286 2180018, Fax:+ 90286 263 59 56.1 650 721 1742. E-mail address: [email protected] (A. Akbal). 7 December 2013
1873-9946/$ - see front matter © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.crohns.2013.12.004 Please cite this article as: Akbal A, et al, Are inflammatory bowel disease patients aware of Achilles tendonitis?, J Crohns Colitis (2013), http:// dx.doi.org/10.1016/j.crohns.2013.12.004