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Upper endoscopic findings in children with active juvenile chronic arthritis
M Ashorn1, P Verronen, T Ruuska
1Department of Paediatrics, University of Tampere, Medical School, Tampere, Finland. merja.ashorn@uta.fi
Insights
Juvenile chronic arthritis patients on NSAIDs may experience gastroduodenal damage. Symptomatic children showed more abnormal endoscopic findings, suggesting a need for evaluation.
Area of Science:
- Pediatric Rheumatology
- Gastroenterology
- Medical Research
Background:
- Juvenile chronic arthritis (JCA) often requires long-term treatment with non-steroidal anti-inflammatory drugs (NSAIDs).
- NSAID use is associated with gastrointestinal complications, including gastroduodenal mucosal damage.
- The relationship between JCA, NSAID treatment, and digestive symptoms in children requires further investigation.
Purpose of the Study:
- To investigate the association between gastroduodenal mucosal damage and digestive tract symptoms in children diagnosed with JCA.
- To assess the prevalence of gastroduodenal inflammation and Helicobacter pylori infection in these patients.
Main Methods:
- A prospective, open-label study involving 45 children with active JCA.
- Gastroscopy was performed to evaluate gastroduodenal mucosa.
- Gastrointestinal symptoms, medication history, hemoglobin, MCV, ESR, and H. pylori status were analyzed.
Main Results:
- Seven children (15.6%) exhibited active gastroduodenal inflammation, with two cases of ulcers and two positive for H. pylori.
- Abnormal endoscopic findings were significantly more prevalent in symptomatic children (75%) compared to asymptomatic ones (38%).
- Abdominal pain increased significantly after medical therapy initiation.
Conclusions:
- Endoscopic evaluation is recommended for JCA patients receiving NSAIDs, particularly those presenting with symptoms.
- The findings highlight the importance of monitoring for gastrointestinal issues in pediatric arthritis patients undergoing NSAID therapy.
Aim:
To investigate the association between gastroduodenal mucosal damage and symptoms of the digestive tract in children with juvenile chronic arthritis (JCA).
Methods:
This was a prospective, open, non-randomized study. Gastroscopy was performed on 45 children with active JCA in 1996-2000. Gastrointestinal symptoms before and during the treatment were noted, as was the length of antirheumatic medication, for which the data were retrospectively assessed. Plasma haemoglobin (Hb) and mean corpuscular volume (MCV) levels and erythrocyte sedimentation rate (ESR) were analysed. Mucosal biopsies were obtained for histology and Helicobacter pylori culture. All patients were taking non-steroidal anti-inflammatory drugs (NSAIDs) and 11 (24.4%) were on peroral steroids; 16 (35.6%) were receiving hydorxychloroquine, 9 salazopyrine, 5 myocrisine and 14 methotrexate.
Results:
Seven children (15.6%) were found to have active inflammation in their gastric and/or duodenal mucosa, two having ulcers and two being infected with H. pylori. Abnormal endoscopic findings were more common in symptomatic children (n = 24) than in children without symptoms (n = 21) (75% vs 38%, p = 0.017). There was no clear association between the Hb or MCV level and the degree of gastroduodenal inflammation (p = 0.98 and 0.7, respectively). Significantly more children (66.6% vs 33.3%) experienced abdominal pain after beginning medical therapy than before therapy (p = 0.02).
Conclusion:
Endoscopic evaluation of patients with JCA and receiving NSAIDs should be considered at least in symptomatic cases.