Musculoskeletal Pain and Inflammatory Bowel Disease Activity Among Adults in Karachi: A Cross-Sectional Study
Article Sidebar
Main Article Content
Abstract
Background: Musculoskeletal pain is a common extraintestinal problem among individuals with inflammatory bowel disease (IBD), but its distribution and relationship with demographic and disease-related characteristics remain incompletely characterized. Objective: To determine the burden and distribution of musculoskeletal pain among individuals with IBD in Karachi and examine its relationship with age, sex, occupation, and IBD-related activity categories. Methods: This cross-sectional study included 233 consecutively recruited participants from gastroenterology and general-practice clinics in Karachi between February and July 2025. Musculoskeletal symptoms were assessed using the Standardised Nordic Musculoskeletal Questionnaire, while IBD-related clinical activity was assessed using Harvey-Bradshaw Index (HBI)- and Simple Clinical Colitis Activity Index (SCCAI)-derived categories. Descriptive statistics and Pearson chi-square tests were applied, with statistical significance defined as p<0.05. Results: Of 233 participants, 178 (76.4%) were female and 147 (63.1%) were aged 21–30 years. Lower-back pain was the most frequently reported regional symptom during both the preceding 12 months (85.8%) and 7 days (80.3%). Based on the study-derived musculoskeletal pain categories, 48 participants (20.6%) had low pain, 134 (57.5%) moderate pain, and 51 (21.9%) high pain. HBI-derived categories comprised 129 participants (55.4%) in remission, 53 (22.7%) with mild activity, and 51 (21.9%) with moderate activity, whereas SCCAI-derived categories comprised 87 (37.3%) in remission, 74 (31.8%) with mild activity, 58 (24.9%) with moderate activity, and 14 (6.0%) with severe activity. Despite descriptive concentration of higher symptom categories among younger participants and women, no statistically significant associations were observed between age, occupation, or sex and musculoskeletal pain, HBI-derived activity, or SCCAI-derived activity; all corresponding chi-square tests yielded p>0.05. Conclusion: Musculoskeletal symptoms were common in this clinical sample of individuals with IBD, particularly involving the lower back, knees, neck, and shoulders. However, demographic characteristics were not significantly associated with musculoskeletal pain or the reported IBD-activity categories. These findings support systematic musculoskeletal assessment in IBD while emphasizing that descriptive subgroup differences should not be interpreted as independent demographic associations without appropriate statistical evidence
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
1. Bourikas LA, Papadakis KA. Musculoskeletal manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 2009;15(12):1915-1924. doi:10.1002/ibd.20942.
2. Steell L, Gray SR, Russell RK, MacDonald J, Seenan JP, Wong SC, et al. Pathogenesis of musculoskeletal deficits in children and adults with inflammatory bowel disease. Nutrients. 2021;13(8):2899. doi:10.3390/nu13082899.
3. Falling C, Stebbings S, Baxter GD, Gearry RB, Mani R. Musculoskeletal pain in individuals with inflammatory bowel disease reflects three distinct profiles. Clin J Pain. 2019;35(7):559-568. doi:10.1097/AJP.0000000000000698.
4. Pettersson N, Kragsbjerg F, Hamrin A, Bergman S, Forsblad-d'Elia H, Karling P. Increased chronic pain in patients with ulcerative colitis is mostly associated to increased disease activity: a cross-sectional case-control study. Scand J Gastroenterol. 2020;55(10):1193-1199.
5. Falling C, Stebbings S, Baxter GD, Siegel CA, Gearry RB, Nijs J, et al. Symptoms of central sensitization in patients with inflammatory bowel diseases: a case-control study examining the role of musculoskeletal pain and psychological factors. Scand J Pain. 2021;21(2):283-295. doi:10.1515/sjpain-2020-0109.
6. Falling CL, Stebbings S, Baxter GD, Siegel CA, Gearry RB, Mani R. Somatosensory assessments in patients with inflammatory bowel disease: a cross-sectional study examining pain processing pathways and the role of multiple patient factors. Eur J Gastroenterol Hepatol. 2022;34(5):503-511.
7. López-Medina C, Molto A, Sieper J, Duruöz T, Kiltz U, Elzorkany B, et al. Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study. RMD Open. 2021;7(1):e001450.
8. Martinis F, Tinazzi I, Bertolini E, Citriniti G, Variola A, Geccherle A, et al. Clinical and sonographic discrimination between fibromyalgia and spondyloarthropathy in inflammatory bowel disease with musculoskeletal pain. Rheumatology (Oxford). 2020;59(10):2857-2863.
9. Muñiz Pedrogo DA, Chen J, Hillmann B, Jeraldo P, Al-Ghalith G, Taneja V, et al. An increased abundance of Clostridiaceae characterizes arthritis in inflammatory bowel disease and rheumatoid arthritis: a cross-sectional study. Inflamm Bowel Dis. 2019;25(5):902-913.
10. Jamal M, Karreman M, de Bruijne F, et al. Impact of musculoskeletal joint complaints on quality of life in patients with inflammatory bowel disease: a cross-sectional study. BMJ Open. 2024;14:e088350.
11. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233-237. doi:10.1016/0003-6870(87)90010-X.
12. Vermeire S, Schreiber S, Sandborn WJ, Dubois C, Rutgeerts P. Correlation between the Crohn's disease activity and Harvey-Bradshaw indices in assessing Crohn's disease severity. Clin Gastroenterol Hepatol. 2010;8(4):357-363. doi:10.1016/j.cgh.2010.01.001.
13. Walmsley RS, Ayres RCS, Pounder RE, Allan RN. A simple clinical colitis activity index. Gut. 1998;43(1):29-32. doi:10.1136/gut.43.1.29.
14. Palm O, Moum BJ, Jahnsen JØ, Gran JT. Fibromyalgia and chronic widespread pain in patients with inflammatory bowel disease: a cross-sectional population survey. J Rheumatol. 2001;28(3):590-594.
15. Tavassoli S, Shahabinasab I, Norouzi A, et al. From bowel inflammation to the bone and joints: musculoskeletal examination in inflammatory bowel disease. BMC Musculoskelet Disord. 2021;22:1019.
16. Freimann T, Coggon D, Merisalu E, Animägi L, Pääsuke M. Risk factors for musculoskeletal pain amongst nurses in Estonia: a cross-sectional study. BMC Musculoskelet Disord. 2013;14:334.
17. Tonelli Enrico V, Vo N, Methe B, et al. An unexpected connection: a narrative review of the associations between gut microbiome and musculoskeletal pain. Eur Spine J. 2022;31:3603-3615.
18. Aboushaala K, Wong AYL, Barajas JN, Lim P, Al-Harthi L, Chee A, et al. The human microbiome and its role in musculoskeletal disorders. Genes (Basel). 2023;14(10):1937.
19. Triadafilopoulos G, Simms RW, Goldenberg DL. Bowel dysfunction in fibromyalgia syndrome. Dig Dis Sci. 1991;36:59-64.
20. Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. JAMA. 2000;284(10):1247-1255. doi:10.1001/jama.284.10.1247.
21. Cuomo A, Parascandola I. Role of nutrition in the management of patients with chronic musculoskeletal pain. J Pain Res. 2024;17:2223-2238.
22. Walsh TP, Arnold JB, Evans AM, et al. The association between body fat and musculoskeletal pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2018;19:233.