title: Enthesitis is an Extraintestinal Manifestation of Pediatric Inflammatory Bowel Disease.
abstract: BACKGROUND
  Enthesitis is an extra-intestinal manifestation of inflammatory bowel disease (IBD) in adults. However, little has been published about the prevalence or characteristics of enthesitis in pediatric IBD.
  
  
  METHODS
  We conducted a cross-sectional study of children and young adults ages 4-21 years with IBD. Subjects were recruited among those receiving routine care in a gastroenterology clinic. All subjects underwent a clinical examination of the entheses and joints, and completed a study questionnaire.
  
  
  RESULTS
  We enrolled 43 subjects, who had a median age of 16 years and a median time from IBD diagnosis of 2.7 years. 32 subjects (74%) had Crohn disease, 10 subjects (23%) had indeterminate colitis, and 1 subject (2%) had ulcerative colitis. At least one tender enthesis was present in 21% of subjects and 12% had more than 2 tender entheses. The most commonly affected entheses were located at the inferior patella, the femoral greater trochanter, and the proximal humerus. The presence of enthesitis was associated with a higher intensity of recent musculoskeletal pain (p=0.03).
  
  
  CONCLUSIONS
  Enthesitis is a prevalent extra-intestinal manifestation of pediatric IBD and is associated with increased musculoskeletal pain. Future studies should evaluate the functional and long-term impact of enthesitis on children with IBD.
authors.affiliation: Division of Rheumatology, Nemours A.I. duPont, Hospital for Children, Wilmington, Delaware, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Horton
authors.affiliation: Center for Childhood Arthritis and Rheumatic Diseases, Children's Hospital of Philadelphia, Philadelphia, USA.
authors.forename: David D
authors.initials: DD
authors.lastname: Sherry
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, USA.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Baldassano
authors.affiliation: Center for Childhood Arthritis and Rheumatic Diseases, Children's Hospital of Philadelphia, Philadelphia, USA.
authors.forename: Pamela F
authors.initials: PF
authors.lastname: Weiss
keywords: Enthesitis; enthesitis-related arthritis; extra-intestinal manifestations; inflammatory bowel disease