[Arthritis as clinical presentation of inflammatory bowel disease in children]

Area of Science:

• Pediatric gastroenterology
• Rheumatology
• Clinical case studies

Background:

• Inflammatory bowel disease (IBD) incidence in children is rising globally.
• Extraintestinal manifestations (EIMs) occur in 6-35% of pediatric IBD patients, with peripheral arthritis being most common.
• Atypical presentations of pediatric IBD can lead to delayed diagnosis and increased intestinal complications.

Observation:

• Two pediatric cases of inflammatory bowel disease are presented.
• The initial symptom in both cases was related to lower limb musculoskeletal issues.
• One child presented with lameness due to peripheral arthritis; the other with enthesitis.

Findings:

• The cases highlight that lameness from peripheral arthritis or enthesitis can be the primary presenting sign of pediatric inflammatory bowel disease.
• These musculoskeletal symptoms can mask the underlying gastrointestinal condition, delaying diagnosis.
• Delayed diagnosis in children with IBD is associated with more severe disease phenotypes and poorer outcomes.

Implications:

• Recognizing musculoskeletal symptoms like lameness, arthritis, and enthesitis is vital for early diagnosis of pediatric inflammatory bowel disease.
• Prompt diagnosis and treatment of pediatric IBD can mitigate the risk of severe intestinal damage and long-term sequelae.
• This underscores the importance of a multidisciplinary approach involving gastroenterologists and rheumatologists in managing pediatric IBD.