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Epidemiology of Musculoskeletal Manifestations in Pediatric Inflammatory Bowel Disease: A Systematic Review
Aaisham Ali1, Melanie Schmidt2, David Piskin2
1Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Insights
This systematic review highlights the varied prevalence of musculoskeletal issues in pediatric inflammatory bowel disease (p-IBD). Standardized assessment and further research are crucial for managing these common extraintestinal manifestations in children.
Area of Science:
- Gastroenterology
- Rheumatology
- Pediatrics
Background:
- Pediatric inflammatory bowel disease (p-IBD) is a chronic condition in children with significant long-term health impacts.
- Musculoskeletal manifestations, particularly joint pain and inflammation, are common extraintestinal complications of p-IBD.
- Current understanding of these musculoskeletal issues in p-IBD, including their characteristics and treatment outcomes, remains limited.
Purpose of the Study:
- To systematically review and summarize the recent literature on the epidemiology of musculoskeletal manifestations in pediatric inflammatory bowel disease (p-IBD).
- To examine patient and disease characteristics, treatments, and outcomes associated with musculoskeletal disease in the context of p-IBD.
- To assess the impact of biologic therapies on musculoskeletal manifestations in p-IBD patients.
Main Methods:
- A comprehensive systematic search was conducted across major biomedical databases (PubMed, Embase, Cochrane Library, Web of Science, CINAHL) for studies published between January 1, 2000, and December 21, 2020.
- Included studies were screened, and relevant data on study/population characteristics and outcomes were extracted.
- Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools to evaluate study quality.
Main Results:
- Thirteen studies, primarily single-center observational studies, were included in the review.
- The prevalence of musculoskeletal manifestations in p-IBD varied widely, ranging from 2% to 35% across studies.
- Significant heterogeneity was observed in diagnostic criteria, definitions, and study quality, with only one study evaluating biologic response.
Conclusions:
- This systematic review is the first to focus on musculoskeletal manifestations in pediatric inflammatory bowel disease (p-IBD).
- The analysis was constrained by considerable variability in study designs, data reporting, and definitions of musculoskeletal issues.
- There is a critical need for standardized assessment methods and further research to optimize the management of musculoskeletal manifestations in children with p-IBD.
Objective:
Pediatric inflammatory bowel disease (p-IBD) is a chronic relapsing gastrointestinal disorder of childhood with long-term morbidity. Several extraintestinal manifestations are described, the most common being joint pain and/or inflammation. However, patient and disease characteristics, treatments, and outcomes of p-IBD-associated musculoskeletal disease are not well established. Our study aims to summarize the recent literature on the epidemiology of musculoskeletal manifestations in p-IBD in the era of biologics.
Methods:
A systematic search of PubMed, Embase, Cochrane Library, Web of Science Core Collection, and Cumulative Index to Nursing and Allied Health Literature databases was performed with relevant keywords. Studies in English published from January 1, 2000, to December 21, 2020, were included. In total, 3893 articles were identified and screened. Study and population characteristics and outcomes of interest were recorded. Risk of bias assessment was performed using the Joanna Briggs Institute Critical Appraisal Tools.
Results:
Thirteen studies were included for full review, which were primarily single-center observational studies with retrospective or cross-sectional designs. The diagnostic criteria and definitions used for musculoskeletal manifestations varied. Musculoskeletal manifestation prevalence ranged from 2% to 35%. Only one study assessed the response of musculoskeletal manifestations to biologics. Risk of bias demonstrated heterogeneity in study quality.
Conclusion:
This is the first systematic review of musculoskeletal manifestations in p-IBD. Analysis was limited because of variability in study design and data-reporting methods. Definitions varied among included studies, with a clear lack in standardization. Our study demonstrates the need for standardized assessment of musculoskeletal manifestations of p-IBD and further research to explore optimal management to advance care for this group of children.
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