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Paediatric Rheumatology

 

Clinical features, treatment patterns and short-term outcomes of children with inflammatory bowel disease evaluated in rheumatology clinic


1, 2, 3, 4, 5

 

  1. Division of Rheumatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA. olcaybilgicdagci@gmail.com
  2. Division of Rheumatology, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA, and Division of Immunology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA.
  3. Division of Rheumatology, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA.
  4. Division of Rheumatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA.
  5. Division of Rheumatology, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA, USA.

CER15193
2022 Vol.40, N°5
PI 1045, PF 1051
Paediatric Rheumatology

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PMID: 35349409 [PubMed]

Received: 25/09/2021
Accepted : 17/01/2022
In Press: 09/03/2022
Published: 13/05/2022

Abstract

OBJECTIVES:
This study evaluated the clinical features, treatment patterns, and short-term outcomes of children with inflammatory bowel disease (IBD)-associated musculoskeletal manifestations.
METHODS:
This was a retrospective cohort study of children with IBD evaluated for joint complaints in a paediatric rheumatology clinic from 2015 to 2020. The index visit was the date of initial rheumatology evaluation. Clinical features were evaluated using standard descriptive statistics. Differences in outcomes over time were compared using rank-sum tests. Univariate logistic regression was used to test associations between clinical features and persistent arthritis or enthesitis.
RESULTS:
Seventy-five patients met inclusion criteria. 61% had active arthritis or enthesitis at initial evaluation, 1/3 of whom were not yet diagnosed with IBD. Of those with known IBD, over half with joint complaints had arthritis or enthesitis. Active joint disease was common even among patients already receiving tumour necrosis factor (TNF) inhibitors or other immunomodulatory medications for IBD and despite inactive gastrointestinal disease. Treatment escalation was often needed to control articular disease, which included changes in immunomodulatory therapy and NSAIDs. Treatment outcomes for arthritis were good and significant improvements in functional mobility were observed (p<0.01), while enthesitis often persisted at follow-up (11/28, 39%). Moreover, a significant proportion of patients with pain at the index visit reported persistent pain at follow-up (29/44, 65%).
CONCLUSIONS:
This study provides several findings relevant to the multidisciplinary care of children with IBD, including high rates of active arthritis and enthesitis despite ongoing use of immunomodulatory medications for the management of IBD, responses to treatment, and pain management

DOI: https://doi.org/10.55563/clinexprheumatol/2xhxrk

Rheumatology Article