Inflammatory Bowel Disease
Inflammatory arthritis is common in inflammatory bowel disease (Crohn's disease and Ulcerative Colitis) and the joint problems can predate the bowel symptoms.
- The arthritis involvement is often Oligoarticular pattern with involvement of joints in the lower limb (knee, ankle or hip), often asymmetrical and can be a monoarthritis.
- There can be an association with HLA B27, enthesitis, acute uveitis and a pattern of joint involvement similar to Enthesitis Related Arthritis.
- The activity of the joint problems tend to fluctuate with the activity of bowel inflammation.
- Inflammatory sacroiliitis (low back pain and morning stiffness) can also occur but tends to not fluctuate with activity of the bowel involvement.
Inflammatory bowel disease should be suspected in a child with joint inflammation with one of more of the following scenarios;
- anaemia or high platelets, high acute phase reactants
- systemic upset (weight loss, anorexia, poor growth)
- gastrointestinal symptoms (mouth ulcers, abdominal pain, change of bowel habit)
- poor growth
- acute uveitis and HLA B27
- erythema nodosum
Referral to gastroenterology is needed.
Management is often combined between paediatric rheumatology and paediatric gastroenterology.
Treatment involves immunosuppression (corticosteroids, methotrexate or sulphasalazine and some children require biologics). Joint injections may be useful.
The photograph below shows a swollen knee in an adolescent with Crohn's disease