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Phenotypic Features and Longterm Outcomes of Pediatric Inflammatory Bowel Disease Patients with Arthritis and
Osnat Nir1,2, Firas Rinawi1,2, Gil Amarilyo1,2
1From the Sackler School of Medicine, Tel Aviv University, Tel Aviv; Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; Rheumatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel.
Insights
Pediatric inflammatory bowel disease (IBD) patients with joint pain show unique characteristics. Joint pain at diagnosis predicts colectomy in ulcerative colitis and future arthritis development in pediatric IBD.
Area of Science:
- Pediatric Gastroenterology
- Rheumatology
- Clinical Outcomes Research
Background:
- The natural history and clinical course of pediatric inflammatory bowel disease (IBD) with joint involvement remain underexplored.
- Understanding these associations is crucial for comprehensive patient management.
Purpose of the Study:
- To investigate the distinct phenotypic features of pediatric IBD patients experiencing joint involvement.
- To determine the clinical outcomes associated with arthritis and arthralgia in this population.
Main Methods:
- Retrospective review of medical records for pediatric IBD patients diagnosed between 2000 and 2016.
- Analysis of outcomes including time to first disease flare, hospitalization, surgery, and initiation of biologic therapy.
Main Results:
- Arthritis and arthralgia were observed in 12.3% and 14.6% of pediatric Crohn disease patients, respectively, and were more common in females.
- Patients with arthritis/arthralgia had lower rates of perianal disease but those with arthritis were more likely to receive biologic therapy.
- In ulcerative colitis (UC), arthralgia at diagnosis predicted higher colectomy rates and was a risk factor for developing arthritis during follow-up.
Conclusions:
- Pediatric IBD patients with arthritis exhibit distinct phenotypic characteristics.
- Arthralgia at diagnosis serves as a significant predictor for colectomy in UC and the development of arthritis in pediatric IBD patients during follow-up.
Objective:
The natural history of pediatric inflammatory bowel disease (IBD) patients with joint involvement has not been clearly described. Thus, we aimed to investigate phenotypic features and clinical outcomes of this distinct association.
Methods:
The medical records of patients with pediatric IBD diagnosed from 2000 to 2016 were reviewed retrospectively. Main outcome measures included time to first flare, hospitalization, surgery, and biologic therapy.
Results:
Of 301 patients with Crohn disease (median age 14.2 yrs), 37 (12.3%) had arthritis while 44 (14.6%) had arthralgia at diagnosis. Arthritis and arthralgia were more common in women (p = 0.028). Patients with arthritis and arthralgia demonstrated lower rates of perianal disease (2.7% and 4.5% vs 16.9%, p = 0.013), whereas patients with arthritis were more likely to be treated with biologic therapy (HR 2.05, 95% CI 1.27-3.33, p = 0.009). Of 129 patients with ulcerative colitis (UC; median age 13.7 yrs), 3 (2.3%) had arthritis and 16 (12.4%) had arthralgia at diagnosis. Patients with arthralgia were treated more often with corticosteroids (p = 0.03) or immunomodulator therapies (p = 0.003) compared with those without joint involvement. The likelihood to undergo colectomy was significantly higher in patients with arthralgia (HR 2.9, 95% CI 1.1-7.4, p = 0.04). During followup (median 9.0 yrs), 13 patients developed arthritis (3.3%). Arthralgia at diagnosis was a significant predictor for the development of arthritis during followup (HR 9.0, 95% CI 2.86-28.5, p < 0.001).
Conclusion:
Pediatric IBD patients with arthritis have distinct phenotypic features. Arthralgia at diagnosis is a predictor for colectomy in UC and a risk factor for the development of arthritis during followup.
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