Challenges in the diagnosis of inflammatory bowel diseases in children: Author's data and a clinical case

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Abstract

Inflammatory bowel diseases (IBD) Crohn's disease (CD) and ulcerative colitis (UC) are a group of idiopathic abnormal bowel conditions with unclear etiology and similar clinical courses. In addition to intestinal syndrome, these diseases are often associated with extraintestinal manifestations, the most common of which is the involvement of the peripheral joints and axial skeleton. The increase in the incidence of IBD, especially CD, in childhood warrants further study of this condition's features, including the most common extraintestinal manifestation: joint involvement (JI) in pediatric patients with IBD.

Aim. To analyze the features of JI in CD and UC and the timing of its occurrence associated with IBD onset.

Materials and methods. We reviewed 146 case histories of patients aged 4 to 18 diagnosed with CD and UC treated in the Gastroenterological Department and Rheumatological Department No.1 of the Mother and Child Center of Sechenov University from 2017 to 2024. The diagnosis of CD and UC was established following the clinical guidelines of the Union of Pediatricians of Russia for diagnosing and treating CD (2021) and UC (2024) in children. A rheumatologist examined the joints and assessed the JI. The classification criteria of the Assessment of SpondyloArthritis International Society (ASAS, 2011) for predominantly peripheral spondyloarthritis and the Garmisch-Partenkirchen JAS Diagnostic Criteria (1987) were used to verify the cause of the joint involvement. Mean values and standard deviation (M±σ) were used to summarize and estimate demographic continuous variables. Absolute values and percentages were calculated for patients in each study group.

Results. Of the 146 patients, 60 (41%) had a combination of JI and IBD. Sixty children aged 4 to 18 with IBD and JI were divided into three groups: 36 (60%) patients with CD, 19 (32%) with UC, and 5 (8%) children with undifferentiated colitis (UndC). The mean age of patients with CD was 14.06±0.5, with UC–13.6±0.3, and UndC–15.2±0.2 years. Among all 60 patients, JI manifested with peripheral arthritis (PA) in 25 (42%) subjects, spondyloarthritis (SpA) in 16 (27%) subjects, or only arthralgias without evident inflammatory changes in the joints in 19 (31%). The analysis of JI variants by groups in children with CD (n=36) showed PA in 15 (42%), SpA in 12 (33%), and isolated arthralgia in 9 (25%) patients. The prevalence of PA and arthralgia among boys and girls with CD was comparable (60 and 40% of PA, 56 and 44% of arthralgias, respectively); the prevalence of SpA in boys with CD was significantly higher: found in 11 (92%) boys. In the group of children with UC (n=19), a high prevalence of PA and isolated arthralgia was reported: 8 (42%) and 9 (47%) patients, respectively. SpA was diagnosed in 2 (11%) children with UC. Of the 60 children with JI and IBD, 30 (50%) developed the disease with joint involvement. CD onset was associated with JI significantly more often than UC onset: of 30 children with JI, 21 (70%) were first diagnosed with rheumatic joint disease, and then CD was detected during follow-up. The disease first manifested with joint involvement in 6 (20%) patients with UC and 3 (10%) with UndC. The time interval from the onset of JI to the onset of the intestinal syndrome (and/or IBD diagnosis) varied widely from 1 month to several years; in 1 patient, it was more than 8 years. In 8 (27%) patients, this time interval was 1 to 3 months; in 6 (20%) patients, the symptoms of the underlying disease appeared within 12 to 24 months from the joint involvement manifestation. The atypical onset and course of the disease make diagnosis challenging and require increased doctor attention to patient management. As an illustration, the article presents a clinical case of an atypical onset and course of CD associated with juvenile SpA.

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About the authors

Angelina V. Polyanskaya

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: meleshkina.angel@mail.ru
ORCID iD: 0000-0002-4125-0335

Cand. Sci. (Med.), Assoc. Prof.

 

Russian Federation, Moscow

Svetlana N. Chebysheva

Sechenov First Moscow State Medical University (Sechenov University)

Email: meleshkina.angel@mail.ru
ORCID iD: 0000-0001-5669-4214

D. Sci. (Med.), Assoc. Prof.

Russian Federation, Moscow

Ekaterina A. Yablokova

Sechenov First Moscow State Medical University (Sechenov University); Clinical Institute of Childhood

Email: meleshkina.angel@mail.ru
ORCID iD: 0000-0003-3364-610X

Cand. Sci. (Med.), Clinical Institute of Childhood

Russian Federation, Moscow; Moscow

Irina M. Korsunskaya

Center for Theoretical Problems of Physical and Chemical Pharmacology; Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology

Email: meleshkina.angel@mail.ru
ORCID iD: 0000-0002-6583-0318

D. Sci. (Med.), Prof.

Russian Federation, Moscow; Moscow

Natalia A. Geppe

Sechenov First Moscow State Medical University (Sechenov University)

Email: meleshkina.angel@mail.ru
ORCID iD: 0000-0003-0547-3686

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Elena V. Borisova

Sechenov First Moscow State Medical University (Sechenov University)

Email: meleshkina.angel@mail.ru
ORCID iD: 0000-0003-4893-6185

Cand. Sci. (Med.)

Russian Federation, Moscow

Elena Yu. Afonina

Sechenov First Moscow State Medical University (Sechenov University)

Email: meleshkina.angel@mail.ru
ORCID iD: 0000-0001-9643-5567

Cand. Sci. (Med.)

Russian Federation, Moscow

Valentina A. Seraya

Sechenov First Moscow State Medical University (Sechenov University)

Email: meleshkina.angel@mail.ru
ORCID iD: 0000-0001-9186-0126

Cand. Sci. (Med.)

Russian Federation, Moscow

Maria N. Nikolaeva

Sechenov First Moscow State Medical University (Sechenov University)

Email: meleshkina.angel@mail.ru
ORCID iD: 0000-0002-6696-1950

Head of Department

Russian Federation, Moscow

Yulia O. Kostina

Sechenov First Moscow State Medical University (Sechenov University)

Email: meleshkina.angel@mail.ru
ORCID iD: 0000-0002-6389-5177

rheumatologist

Russian Federation, Moscow

Veronika V. Kimutsadze

Sechenov First Moscow State Medical University (Sechenov University)

Email: meleshkina.angel@mail.ru
ORCID iD: 0009-0006-7791-4881

student

Russian Federation, Moscow

Valeriia V. Kimutsadze

Sechenov First Moscow State Medical University (Sechenov University)

Email: meleshkina.angel@mail.ru
ORCID iD: 0009-0001-4084-3921

student

Russian Federation, Moscow

References

  1. Никитин А.В., Волынец Г.В., Скворцова Т.А., Капранова М.С. Внекишечные проявления воспалительных заболеваний кишечника. Доказательная гастроэнтерология. 2023;12(1):93-8 [Nikitin AV, Volynets GV, Skvortsova TA, Kapranova MS. Extraintestinal manifestations of inflammatory bowel disease. Russian Journal of Evidence-Based Gastroenterology. 2023;12(1):93-8 (in Russian)]. doi: 10.17116/dokgastro20231201193
  2. Vavricka SR, Schoepfer A, Scharl M, et al. Extraintestinal Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis. 2015;21(8):1982-92. doi: 10.1097/MIB.0000000000000392
  3. Harbord M, Annese V, Vavricka SR, et al. The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis. 2016;10(3):239-54. doi: 10.1093/ecco-jcc/jjv213
  4. Яблокова Е.А., Хавкин А.И., Полянская А.В., и др. Внекишечные проявления воспалительных заболеваний кишечника у детей: фокус на опорно-двигательный аппарат. Вопросы практической педиатрии. 2023;18(4):62-72 [Yablokova EA, Khavkin AI, Polyanskaya AV, et al. Extraintestinal manifestations of inflammatory bowel disease in children: focus on the musculoskeletal system. Vopr prakt pediatr (Clinical Practice in Pediatrics). 2023;18(4):62-72 (in Russian)]. doi: 10.20953/1817-7646-2023-4-62-72
  5. Мелешкина А.В., Шахбазян И.Е., Жолобова Е.С., и др. Спондилоартропатии при хронических воспалительных заболеваниях кишечника. Педиатрия. Consilium Medicum. 2008;(2):46-8. Meleshkina AV, Shakhbazian IE, Zholobova ES, et al. Spondiloartropatii pri khronicheskikh vospalitelnykh zabolevaniiakh kishechnika. Pediatrics. Consilium Medicum. 2008;(2):46-8 (in Russian)].
  6. Болезнь Крона у детей. Клинические рекомендации, 2021 г. Режим доступа: https://cr.minzdrav.gov.ru/recomend/682_1. Ссылка активна на 11.09.2024 [Bolezn Krona u detei. Klinicheskie rekomendatsii, 2021. Available at: https://cr.minzdrav.gov.ru/recomend/682_1. Accecced: 11.09.2024 (in Russian)].
  7. Язвенный колит у детей. Клинические рекомендации. Режим доступа: https://www.pediatr russia.ru/information/klin-rek/proekty metodicheskikhrekomendatsiy/949_ЯК_пересмотр_2024_июнь2.pdf. Ссылка активна на 11.09.2024 [Iazvennyi kolit u detei. Klinicheskie rekomendatsii. Available at: https://www.pediatr russia.ru/information/klin-rek/proekty metodicheskikhrekomendatsiy/949_ЯК_пересмотр_2024_июнь2.pdf. Accecced: 11.09.2024 (in Russian)].
  8. Горелов А.В., Каннер Е.В. Воспалительные заболевания кишечника у детей: особенности течения и терапии. Медицинский совет. 2018;(2):140-5 [Gorelov AV, Kanner EV. Inflammatory bowel diseases in children: peculiarities of the disese course and therapy. Meditsinskiy sovet = Medical Council. 2018;(2):140-5 (in Russian)]. doi: 10.21518/2079-701X-2018-2-140-145
  9. Turkcapar N, Toruner M, Soykan I, et al. The prevalence of extraintestinal manifestations and HLA association in patients with inflammatory bowel disease. Rheumatol Int. 2006;26(7):663-8.
  10. Karreman MC, Luime JJ, Hazes JMW, Weel AEAM. The Prevalence and Incidence of Axial and Peripheral Spondyloarthritis in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis. 2017;11(5):631-42. doi: 10.1093/ecco-jcc/jjw199
  11. Ali A, Schmidt M, Piskin D, et al. Epidemiology of Musculoskeletal Manifestations in Pediatric Inflammatory Bowel Disease: A Systematic Review. ACR Open Rheumatol. 2022;4(6):547-54. doi: 10.1002/acr2.11431
  12. Жолобова Е.С., Юсупова В.Т., Афонина Е.Ю., и др. Воспалительные заболевания кишечника у пациентов с системным ювенильным артритом. Consilium Medicum. 2023;25(8):530-4 [Zholobova ES, Yusupova VT, Afonina EIu, et al. Inflammatory bowel disease in patients with systemic juvenile idiopathic arthritis. Inflammatory bowel disease in patients with systemic juvenile arthritis: Case report. Consilium Medicum. 2023;25(8):530-4 (in Russian)]. doi: 10.26442/20751753.2023.8.202357
  13. Van Rheenen PF, Aloi M, Assa A, et al. The Medical Management of Paediatric Crohn's Disease: an ECCO-ESPGHAN Guideline Update. J Crohns Colitis. 2020:jjaa161. doi: 10.1093/ecco-jcc/jjaa161

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