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Enthesitis is an Extraintestinal Manifestation of Pediatric Inflammatory Bowel Disease
Daniel B Horton1, David D Sherry2, Robert N Baldassano3
1Division of Rheumatology, Nemours A.I. duPont, Hospital for Children, Wilmington, Delaware, USA.
Insights
Enthesitis, a common condition in adults with inflammatory bowel disease (IBD), affects children with IBD too. This study found enthesitis in pediatric IBD patients is linked to greater musculoskeletal pain.
Area of Science:
- Pediatric rheumatology
- Gastroenterology
- Inflammatory bowel disease research
Background:
- Enthesitis is a known extra-intestinal manifestation in adult inflammatory bowel disease (IBD).
- Limited data exists on the prevalence and characteristics of enthesitis in pediatric IBD patients.
Purpose of the Study:
- To determine the prevalence and characteristics of enthesitis in children and young adults with IBD.
- To investigate the association between enthesitis and musculoskeletal pain in this population.
Main Methods:
- A cross-sectional study was conducted on 43 IBD patients aged 4-21 years undergoing routine gastroenterology care.
- Clinical examinations of entheses and joints, alongside questionnaire data, were used to assess enthesitis and pain.
- Subjects included those with Crohn disease, indeterminate colitis, and ulcerative colitis.
Main Results:
- Enthesitis was present in 21% of pediatric IBD subjects, with 12% experiencing more than two tender entheses.
- Commonly affected sites included the inferior patella, femoral greater trochanter, and proximal humerus.
- A statistically significant association was found between enthesitis and higher intensity of recent musculoskeletal pain (p=0.03).
Conclusions:
- Enthesitis is a prevalent extra-intestinal manifestation in pediatric IBD.
- The presence of enthesitis correlates with increased musculoskeletal pain in children with IBD.
- Further research is needed to understand the functional and long-term effects of enthesitis in pediatric IBD.
Background:
Enthesitis is an extra-intestinal manifestation of inflammatory bowel disease (IBD) in adults. However, little has been published about the prevalence or characteristics of enthesitis in pediatric IBD.
Methods:
We conducted a cross-sectional study of children and young adults ages 4-21 years with IBD. Subjects were recruited among those receiving routine care in a gastroenterology clinic. All subjects underwent a clinical examination of the entheses and joints, and completed a study questionnaire.
Results:
We enrolled 43 subjects, who had a median age of 16 years and a median time from IBD diagnosis of 2.7 years. 32 subjects (74%) had Crohn disease, 10 subjects (23%) had indeterminate colitis, and 1 subject (2%) had ulcerative colitis. At least one tender enthesis was present in 21% of subjects and 12% had more than 2 tender entheses. The most commonly affected entheses were located at the inferior patella, the femoral greater trochanter, and the proximal humerus. The presence of enthesitis was associated with a higher intensity of recent musculoskeletal pain (p=0.03).
Conclusions:
Enthesitis is a prevalent extra-intestinal manifestation of pediatric IBD and is associated with increased musculoskeletal pain. Future studies should evaluate the functional and long-term impact of enthesitis on children with IBD.
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