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Sacroiliac joint involvement in children with inflammatory bowel diseases
Nelgin Gerenli1, Betul Sozeri2, Sevinc Kalin3
1Department of Pediatric Gastroenterology and Hepatology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey.
Insights
Sacroiliitis (SI) affects 30% of children with inflammatory bowel diseases (IBDs), particularly those with Crohn's disease (CD). Early detection through pediatric rheumatology and gastroenterology collaboration is crucial for managing this inflammatory arthropathy.
Area of Science:
- Pediatric Rheumatology
- Pediatric Gastroenterology
- Inflammatory Arthropathies
Background:
- Sacroiliitis (SI), an inflammatory arthropathy, can be associated with pediatric inflammatory bowel diseases (IBDs).
- SI may present with non-specific back pain, potentially leading to delayed diagnosis in children.
- Assessing the prevalence and characteristics of SI in pediatric IBD patients is essential for timely management.
Purpose of the Study:
- To determine the frequency of sacroiliitis (SI) in children diagnosed with inflammatory bowel diseases (IBDs).
- To characterize the association between SI and the clinical features of IBD in pediatric patients.
- To identify risk factors and clinical patterns of SI in children with IBD.
Main Methods:
- A prospective, cross-sectional study evaluated 27 children (ages 7-18) with IBD.
- Patients with relevant symptoms underwent clinical examination, X-ray, and Magnetic Resonance Imaging (MRI) for SI diagnosis.
- HLA-B27 genotyping was performed on patients with SI.
Main Results:
- Sacroiliitis (SI) was diagnosed in 8 out of 27 (30%) pediatric IBD patients.
- Children with Crohn's disease (CD) showed a higher prevalence of SI (45%) compared to ulcerative colitis (UC) patients (21%).
- MRI revealed bone marrow edema in all SI patients, with erosions and synovial enhancement in a majority.
Conclusions:
- Sacroiliitis (SI) is a notable comorbidity in pediatric inflammatory bowel diseases (IBDs), often remaining undiagnosed.
- Pediatric patients with Crohn's disease (CD) have a higher predisposition to developing SI.
- Enhanced collaboration between pediatric rheumatology and gastroenterology services can improve screening and management of SI in at-risk pediatric IBD patients.
Objective:
Sacroiliitis (SI), an inflammatory arthropathy, may accompany pediatric inflammatory bowel diseases (IBDs), present with non- specific back pain, hence might be unnoticed. The aims of this study were to assess the frequency of the SI in children with IBD and determine the characteristics of the association of SI with the clinical hallmarks of the IBD.
Methods:
In this prospective, cross sectional study, twenty-seven children with IBD, 7-18 years of age were evaluated. Patients with low back pain or stiffness, alternating buttock pain, or hip pain were examined for the presence of SI. The radiologic manifestations on X-ray suggesting sacroilitis were confirmed with Magnetic resonance imaging (MRI).
Results:
Twenty-seven children (16 girls, female/male=1.45), with mean age of 12.55±3.6 years, of which 52% had ulcerative colitis (UC), 41% had Crohn's disease (CD), and two had indeterminate colitis (IC). The median time from IBD diagnosis was 6.0 (18.0) months for patients with SI and 12.0 (13.5) months for patients without SI. Low back pain or stiffness was observed in 13 patients (48%). SI was present in eight (30%) of the children with IBD. The patients with CD were more prone to SI (45% of CD vs. 21% of UC patients). All patients with SI were negative for HLA-B27 genotyping. The disease activity and gender were not associated with increased risk for SI. MRI was remarkable for bone marrow edema in all of the patient, followed by erosions in six of them (75%), synovial enhancement observed in five (63%), and erosion associated enthesitis of the pelvic region was observed in two (25%) of the patients.
Conclusion:
SI may remain obscured in children with IBD. Children with CD are more prone to SI than those with UC. Pediatric rheumatology-pediatric gastroenterology collaboration might augment screening in at-risk patients.
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