Inflammatory Bowel Disease
Inflammatory arthritis is common in inflammatory bowel disease (Crohn's disease and Ulcerative Colitis) and the joint problems can pre-date 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.
- The joint problems may predate the onset of gastrointestinal symptoms.
- Gut inflammation due to infections needs to be considered if there has been a recent relevant travel history.
- Inflammatory sacroiliitis (low back pain and morning stiffness) can also occur but tends not to fluctuate with activity of the bowel involvement.
- 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 for peripheral joint arthritis. More information is available in pmm-nursing.
Inflammatory bowel disease should be suspected in a child with joint inflammation with one or more of the following scenarios and especially when the joint disease appears to be well controlled:
- Anaemia or high platelets, high acute phase reactants, hypoalbuminaemia.
- Systemic upset (weight loss, anorexia, poor growth).
- Gastrointestinal symptoms (mouth / oral ulcers, abdominal pain, change of bowel habit). and apparent 'intolerance of NSAIDs'.
- Acute uveitis and HLA-B27.
- Erythema nodosum.
The photograph below shows a swollen knee in an adolescent with Crohn's disease