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Enthesitis: an obscured extraintestinal manifestation in pediatric inflammatory bowel disease
Nelgin Gerenli1, Betül Sözeri2
1Departments of Pediatric Gastroenterology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey.
Insights
Enthesitis, an underdiagnosed condition in pediatric inflammatory bowel disease (IBD), affects nearly half of children studied. This common manifestation impacts musculoskeletal pain but not physical activity.
Area of Science:
- Pediatric rheumatology
- Gastroenterology
- Inflammatory Bowel Disease (IBD) research
Background:
- Enthesitis is an underdiagnosed extra-intestinal manifestation in pediatric inflammatory bowel disease (IBD).
- Early identification of enthesitis is crucial for managing musculoskeletal health in children with IBD.
Purpose of the Study:
- To determine the frequency of enthesitis in pediatric IBD patients.
- To utilize physical examination and ultrasound (US) as reference standards for enthesitis assessment.
Main Methods:
- A cross-sectional study involving 31 children (aged 7-18) diagnosed with IBD.
- Participants underwent physical examination, ultrasound, and completed a questionnaire.
- Enthesitis was assessed using both clinical examination and US findings.
Main Results:
- Enthesitis was identified in 45% of pediatric IBD patients (14 out of 31).
- The quadriceps femoris insertion was the most frequently affected site.
- Enthesitis correlated with increased musculoskeletal pain intensity (p=0.018).
Conclusions:
- Enthesitis is a common and underestimated complication in pediatric IBD.
- Further research with larger cohorts is needed to understand the long-term impact of enthesitis on children with IBD.
Background:
Enthesitis is an extra-intestinal manifestation of inflammatory bowel disease (IBD) which often remains underdiagnosed in children. We aimed to evaluate the frequency of enthesitis in pediatric IBD patients using physical examination and ultrasound (US) assessment as the reference standard.
Methods:
31 children, 7 -18 years of age, diagnosed with IBD were recruited for a cross-sectional study. All subjects completed a study questionnaire and underwent both physical and US examination for the presence of the enthesitis.
Results:
Of 31 subjects (17girls; median age 14(6) years) enrolled, 17 (55%) had ulcerative colitis, 11 (35%) had Crohn`s disease, and 3 (10%) had indeterminate colitis. The median time from IBD diagnosis was 1.2 years. At least one enthesitis (range 1-4) was identified in 14 (45%) patients of whom nine had more than one enthesitis with symmetric involvement in eight. The quadriceps femoris insertion at the superior portion of the patella was the frequently involved site (32%, 9 of 28 sites), followed by patellar ligament insertion at tibial tuberositas. The presence of enthesitis was associated with a higher intensity of the musculoskeletal pain (p=0.018), but physical activity remained unaffected (p=0.056).
Conclusions:
Enthesitis is a common underestimated extra-intestinal manifestation of IBD that may impact the musculoskeletal health of children. Future studies with more extensive cohorts are needed to evaluate enthesial involvement both with physical examination and US in order to predict the long-term outcomes of the enthesitis on children with IBD.
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