Inflammatory Bowel Disease
Inflammatory arthritis is common in children with inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis.
Importantly, joint symptoms may occur before gastrointestinal features, so early recognition is essential.
Patterns of arthritis in IBD
Arthritis associated with IBD can affect the peripheral joints or the axial skeleton.
Peripheral arthritis typically affects one to three joints, most often the lower limbs (knees, ankles or hips), and is usually asymmetrical. Flares of peripheral arthritis often parallel bowel disease activity.
Axial involvement, such as sacroiliitis, presents with low back pain and morning stiffness and may not correlate with bowel disease activity.
Associated features may include enthesitis, HLA-B27 positivity and acute anterior uveitis, reflecting overlap with the spondyloarthritis spectrum.
When to suspect IBD in a child with arthritis
- anaemia, thrombocytosis or raised inflammatory markers
- weight loss, anorexia or poor growth
- abdominal pain, mouth ulcers or altered bowel habit
- growth failure
- acute uveitis, particularly with HLA-B27 positivity
- erythema nodosum
Management
Management requires close collaboration between paediatric rheumatology and paediatric gastroenterology.
- Treatment may include:
- corticosteroids, methotrexate or sulfasalazine
- targeted immunotherapies in selected cases
- intra-articular steroid injections for joint-specific disease
Care should also address growth, nutrition and overall wellbeing.
Key points for healthcare professionals
- Arthritis may precede gastrointestinal symptoms, so consider IBD in children with joint inflammation and systemic features
- Peripheral and axial disease behave differently, and sacroiliitis may not reflect bowel activity
- Always assess growth, nutrition and systemic health
Joint care between rheumatology and gastroenterology is essential to optimise outcomes
