1IRCCS Materno-Infantile “Burlo Garofolo”, Trieste; 2Università di Trieste
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Key words: Inflammatory Bowel Disease, Arthritis, Crohn’s disease, Ulcerative colitis
Background - Up to 36% of children affected by an Inflammatory Bowel Disease (IBD)
have an associated extraintestinal manifestation, which in 7-25% cases consists in an articular
Objective - The aim of the present study is to describe the features of the articular involvement in children with IBD.
Materials and methods - Clinical records of patients with IBD followed by the IRCCS “Burlo Garofolo” (Trieste, Italy) between 1987 and 2015 were evaluated. The type of IBD, the localization and behaviour of the disease, according with the Paris Classification, the presence of articular involvement and its feature, according to the European Spondyloarthropathy Study Group’s classification, and treatments were analysed. Features of children with and without articular involvement were compared.
Results - 13 out of 240 patients affected by IBD (5%) presented with an articular involvement: 11 out of 13 patients with articular manifestation had Crohn’s disease; 2 had ulcerative colitis and 9 patients had a peripheral arthritis with polyphasic evolution dependent on the intestinal inflammation. Articular involvement was contemporary with the onset of bowel disease in 5 (38%) cases, previous in 4 (31%) cases and subsequent in 4 (31%) cases. Compared with controls, patients with CD and arthritis more frequently presented with a complicated disease - in Crohn’s disease stricturing and penetrating phenotype 2/11 (18%) cases vs 3/111 (3%) - and had a more frequent use of immunosoppressive drugs - methotrexate 4/13 (30%) cases vs 26/227 (11%) controls and infliximab 12/13 (92%) cases vs 82/227 (36%) controls.
Conclusion - In the present study 5% of children with IBD had an associated arthritis mostly involving peripheral joints, presenting at the same time of the bowel disease and evolving as a polyphasic disease. The arthritis was significantly more frequent in children with CD and in these cases the intestinal disease had a more complicated disease phenotype that required a more frequent use of immunosuppressive drugs and biologics.
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