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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.


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