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The Prevalence of Inflammatory Bowel Disease in Juvenile Spondyloarthritis
Ipek Ulkersoy1, Umit Gul2, Mehmet Yildiz2
1Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Insights
Elevated fecal calprotectin (FCP) can indicate silent intestinal inflammation in children with juvenile spondyloarthritis (JSpA). This noninvasive marker aids in early detection of inflammatory bowel disease (IBD) in these at-risk patients.
Area of Science:
- Pediatric rheumatology
- Gastroenterology
- Immunology
Background:
- Juvenile spondyloarthritis (JSpA) shares features with pediatric inflammatory bowel disease (IBD), increasing JSpA patients' risk for IBD.
- Early identification of IBD in JSpA is crucial for timely diagnosis and management.
Purpose of the Study:
- To determine the prevalence of IBD in children with JSpA.
- To identify early, noninvasive markers for IBD detection in JSpA patients.
- To enhance diagnostic, screening, and treatment strategies for IBD in JSpA.
Main Methods:
- Prospective evaluation of children diagnosed with JSpA.
- Measurement of fecal calprotectin (FCP) in all participants.
- Ileocolonoscopy with histopathological and radiological assessment for those with elevated FCP or IBD-related symptoms.
Main Results:
- 17.3% of JSpA patients were diagnosed with colitis.
- Elevated FCP levels were found in 19 children, with 68.4% showing mucosal changes.
- 94.7% of children with elevated FCP were asymptomatic for IBD, highlighting FCP's role in detecting subclinical inflammation.
- Sacroiliitis was more frequent in FCP-positive and colitis-positive patients.
Conclusions:
- Inflammatory bowel disease and subclinical colitis are common in juvenile spondyloarthritis.
- Elevated fecal calprotectin is a valuable noninvasive biomarker for detecting silent intestinal inflammation in JSpA.
- Ileocolonoscopy is warranted to confirm findings suggested by elevated FCP levels.
Objectives:
Juvenile spondyloarthritis (JSpA) shares genetic, immunopathogenic, and environmental features with pediatric inflammatory bowel disease (IBD), placing patients at an elevated risk for IBD. We aimed to evaluate the prevalence of IBD and identify potential early markers for its recognition in children with JSpA, trying to improve its diagnostic, screening, and treatment strategies.
Methods:
Children diagnosed with JSpA were prospectively evaluated. Fecal calprotectin (FCP) was measured in all participants, and those with elevated FCP (> 100 μg/g) or two or more IBD-related symptoms (chronic diarrhea, weight loss/growth retardation, abdominal pain, or bloody/mucous stool) underwent ileocolonoscopy with histopathological and radiological assessment.
Results:
Altogether 81 children (71.6% male) with a mean age of 194 months at adimission were included, and 23 underwent endoscopic evaluation (19 for elevated FCP, 4 for two or more IBD-related symptoms). Among them, 10 (43.5%) had both macroscopic and microscopic presentation of colitis, 4 (17.4%) had microscopic appearance only, and 9 (39.1%) had normal histopathological findings. Notably, 94.7% of children with elevated FCP levels were asymptomatic for IBD. Among FCP-positive patients, 13 (68.4%) showed macroscopic and/or microscopic mucosal changes. Overall, colitis was confirmed in 14 (17.3%) patients. Sacroiliitis, as confirmed by magnetic resonance imaging, was significantly more frequent among both FCP-positive and colitis-positive patients (p < 0.001 and p = 0.008, respectively). No significant associations were found between FCP levels or intestinal inflammation and disease activity, acute-phase reactants, or treatment status.
Conclusions:
IBD and subclinical colitis are relatively frequent in JSpA. Elevated FCP represents a promising noninvasive biomarker for detecting silent intestinal inflammation, warranting confirmation by ileocolonoscopy.
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