Musculoskeletal Manifestations as Presenting Symptoms of Inflammatory Bowel Disease in Children and Adolescents

Levy, Rachel; Amarilyo, Gil; Tal, Rotem; Amir, Jacob; Assa, Amit; Rinawi, Firas; Harel, Liora

doi:10.1016/j.jpeds.2018.12.005

Cited by 6 publications

(11 citation statements)

References 9 publications

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“…Included studies were primarily observational single‐center studies ( 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ) (Table 1 ). These were most commonly retrospective cohort studies with limited prospective follow‐up.…”

Section: Resultsmentioning

confidence: 99%

“…They also found that patients with arthralgia at initial IBD diagnosis were more likely to later develop arthritis compared with those without arthralgia at IBD diagnosis. In a case–control study, it was demonstrated that in patients with arthritis associated with p‐IBD, compared with those with arthritis of other causes, there was significantly increased ESR, CRP level, sacroiliac involvement, arthralgia, and additive arthritis and a significantly decreased white blood cell count and hemoglobin level ( 25 ). Only one article looked at fecal calprotectin levels ( 25 ), which demonstrated elevated levels in the patients with p‐IBD compared with the controls without known intestinal disease, but unfortunately no studies compared p‐IBD with and without MSK EIMS.…”

Section: Resultsmentioning

confidence: 99%

“…The definitions used also varied, with MSK-related features, such as peripheral arthritis, axial arthritis, enthesitis, and arthralgia, included (Table 2, see Supplementary Table 2 for further definition information). The most commonly reported joints affected by peripheral arthritis and arthralgia were the knees and ankles (25,27,29). Disease course.…”

Section: Study Population and Definitionsmentioning

confidence: 99%

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Epidemiology of Musculoskeletal Manifestations in Pediatric Inflammatory Bowel Disease: A Systematic Review

Ali

Schmidt

Piskin

et al. 2022

ACR Open Rheumatology

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Objective Pediatric inflammatory bowel disease (p‐IBD) is a chronic relapsing gastrointestinal disorder of childhood with long‐term morbidity. Several extraintestinal manifestations are described, the most common being joint pain and/or inflammation. However, patient and disease characteristics, treatments, and outcomes of p‐IBD‐associated musculoskeletal disease are not well established. Our study aims to summarize the recent literature on the epidemiology of musculoskeletal manifestations in p‐IBD in the era of biologics. Methods A systematic search of PubMed, Embase, Cochrane Library, Web of Science Core Collection, and Cumulative Index to Nursing and Allied Health Literature databases was performed with relevant keywords. Studies in English published from January 1, 2000, to December 21, 2020, were included. In total, 3893 articles were identified and screened. Study and population characteristics and outcomes of interest were recorded. Risk of bias assessment was performed using the Joanna Briggs Institute Critical Appraisal Tools. Results Thirteen studies were included for full review, which were primarily single‐center observational studies with retrospective or cross‐sectional designs. The diagnostic criteria and definitions used for musculoskeletal manifestations varied. Musculoskeletal manifestation prevalence ranged from 2% to 35%. Only one study assessed the response of musculoskeletal manifestations to biologics. Risk of bias demonstrated heterogeneity in study quality. Conclusion This is the first systematic review of musculoskeletal manifestations in p‐IBD. Analysis was limited because of variability in study design and data‐reporting methods. Definitions varied among included studies, with a clear lack in standardization. Our study demonstrates the need for standardized assessment of musculoskeletal manifestations of p‐IBD and further research to explore optimal management to advance care for this group of children.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Population and Definitionsmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology of Musculoskeletal Manifestations in Pediatric Inflammatory Bowel Disease: A Systematic Review

Ali

Schmidt

Piskin

et al. 2022

ACR Open Rheumatology

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“…Of patients in our cohort who had arthritis any time during their CD, 62% (18/29) had arthritis at the onset of CD, and this predicts a more severe disease course. To obtain earlier diagnoses, every child presenting with acute or chronic arthritis should be assessed for IBD at least by specific personal history of gastrointestinal symptoms as well as a family history of IBD [ 12 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study, arthritis was the first presenting symptom in 4% of children and adolescents with IBD. Clinical manifestations of CD-associated arthropathies vary, and include asymmetrical, transitory and migratory arthritis (pauciarticular or polyarticular), peripheral joint pain and spondyloarthropathy [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Joint involvement, disease activity and quality of life in pediatric Crohn’s disease – a cross-sectional study

et al. 2022

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Background Few published data describe how joint involvement, the most prevalent extraintestinal manifestation, affects quality of life (QoL) of children with Crohn’s disease (CD). Arthritis and arthralgia rates in pediatric CD patients are reportedly 3–24% and 17–22%, respectively, but studies on pre-emptive and systematic screening of joint involvement with detailed musculoskeletal rheumatological exam are lacking. More detailed data collection on joint involvement improves our understanding of how arthropathy relates to disease activity and QoL measured by the Pediatric CD Activity Index (PCDAI) and IMPACT-III questionnaire. Our study aims were to assess joint involvement in pediatric CD and correlate it with the PCDAI and IMPACT-III. Methods In this cross-sectional, observational study, a pediatric gastroenterologist assessed consecutively-seen pediatric CD patients at a tertiary care center. Patients were screened for prevalence of current and previous arthropathy, including arthritis, enthesitis and arthralgia. A single experienced pediatric rheumatologist evaluated detailed musculoskeletal history, joint status, and modified Juvenile Arthritis Multidimensional Assessment Reports (JAMAR). PCDAI, IMPACT-III, sacroiliac MRI, and HLA-B27 genetic testing were also completed. Results A total of 82 (male:female, 1.2:1; age, 13.7 ± 3.2 years) patients were involved in this study. Mean disease duration at time of study was 21.6 ± 21 months; eight of the patients were newly-diagnosed. Of the 82 patients, 29 (35%) had evidence of arthritis; for 24 of those, this was revealed by physical exam during cross-sectional screening, and by prior documentation for the remaining five patients. Joint examination confirmed active arthritis in 8/24 (33%), active enthesitis in 1/24 (4%), and evidence of previous arthritis in 15/24 (62.5%) patients. Hip (41%) and knee (38%) joints were most commonly affected. Cumulative incidence of arthralgia was 48% (39/82), and 46% (18/39) of those patients had only arthralgia without arthritis, usually affecting the knee. Axial involvement was present in 10/82 (12%) patients. Joint involvement correlated with more severe CD disease activity, specifically higher PCDAI and lower IMPACT-III scores, and increased requirement for infliximab treatment. Sacroiliitis and HLA-B27 positivity were insignificant factors in this cohort. Conclusions When a rheumatologist performed the assessment, joint involvement in pediatric CD was more prevalent than previously reported, in this cross-sectional study. Arthritis was associated with more severe CD disease activity and lower QoL.

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Clues for inflammatory diseases in the differential diagnosis of a child with sacroiliitis

Karagöl

Güngörer

Tekin

et al. 2023

Pediatrics International

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BackgroundThe purpose of this study was to compare the demographic, clinical and laboratory characteristics of patients with enthesitis‐related arthritis (ERA), familial Mediterranean fever (FMF) and inflammatory bowel disease (IBD), which are inflammatory diseases that may develop sacroiliitis. Thus, it was aimed to reveal various findings that may indicate primary disease in patients with sacroiliitis.MethodsPediatric patients aged 6–18 years, who were being followed with a diagnosis of ERA (n = 62), FMF (n = 590), and IBD (n = 56) over the period 2013–2021 were included in the study. Sacroiliitis (n = 55) was diagnosed by magnetic resonance imaging of the sacroiliac joint, obtained from clinically suspected patients.ResultsSacroiliitis was detected in 54.8% of ERA patients, 2.3% of FMF patients, and 12.5% of IBD patients. The mean follow‐up period was 4.1 ± 2.8 years (10 months‐8 years) for the entire study group. The most common MRI finding for sacroiliitis was bone marrow edema. Peripheral joint involvement (73.5%) and HLA B27 positivity (64.7%) was significantly higher in ERA patients, and ERA was diagnosed more frequently in patients presenting with sacroiliitis. Non‐steroidal anti‐inflammatory drugs (NSAIDs) were the first choice of treatment agent when sacroiliitis developed in all three patient groups.ConclusionsThe clinical and laboratory findings of ERA, FMF and IBD can sometimes be intertwined or can even coexist. Treatment may differ depending on the disease associated with sacroiliitis, although NSAIDs may be used in the first‐line treatment of all three diseases. Sacroiliitis patients with HLA B27 positivity and peripheral arthritis may need to be addressed as ERA.

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Musculoskeletal Manifestations as Presenting Symptoms of Inflammatory Bowel Disease in Children and Adolescents

Cited by 6 publications

References 9 publications

Epidemiology of Musculoskeletal Manifestations in Pediatric Inflammatory Bowel Disease: A Systematic Review

Epidemiology of Musculoskeletal Manifestations in Pediatric Inflammatory Bowel Disease: A Systematic Review

Joint involvement, disease activity and quality of life in pediatric Crohn’s disease – a cross-sectional study

Clues for inflammatory diseases in the differential diagnosis of a child with sacroiliitis

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