835 Can Ustekinemab Relieve the Symptoms of IBD-Associated Arthropathy?

Abstract

INTRODUCTION: Arthropathy is the most common extra intestinal manifestation observed in patients with Inflammatory Bowel Disease (IBD). Various studies have shown that up to 40% or more of patients with IBD may experience arthropathy. Ustekinemab is a relatively new drug approved for the management of moderate to severe Crohn’s disease (Oct 2016) and phase 3 trials for ulcerative colitis have now been completed. It is also FDA approved for management of psoriatic arthritis. The purpose of this study was to determine if a small cohort of patients with enteroarthropathy had symptom improvement while receiving ustekinemab in a longitudinal retrospective cohort. METHODS: Adult patients with IBD and arthropathy with who were treated with ustekinumab were included in the cohort. We followed the minimal disease activity index (MDA) which includes 7 broadly accepted parameters. We chose to collect data on 5 of those parameters including 1) joint tenderness, 2) swollen joint count, 3) tender points, 4) standardized graphic pain scales (VAS or GRS), and 5) a global assessment score from 0-5 (GAS). Two parameters (psoriatic area and severity index and health disability index) were not assessed. At each visit outcome measures were evaluated for changes in arthritic symptoms. RESULTS: 15 patients were included for review. 11 had Crohn’s disease and 4 had ulcerative colitis. Patients were followed for an average of 12 months (range 9-16). Eleven of 15 patients had joint tenderness on palpation at the start of therapy with 1 to 3 affected joints per patient while the others had subjective tenderness. Five patients had visibly swollen joints and 1 had both. The mean GAS was 3 with a range of 2 to 4. The pain GRS had a mean score of four out of 10 with a range of 2 to 8. The mean number of tender points was 3. After ustekinumab therapy, 14 of 15 patients had a drop in the global assessment score and the pain GRS score. Fourteen patients had resolution of joint swelling and tenderness. At the conclusion of the study, 6 of 15 patients complete resolution of all five scales. Four patients had resolution in three of the five scales, while 4 patients had resolution of two of the five scales. 1 patient did not exhibit improvement in any area. CONCLUSION: In this small observational cohort, ustekinumab improved arthropathy in 14 of 15 patients. We hope this stimulates interest in trials observing larger number of patients with this debilitating extra international manifestation of IBD.