title: Current issues in pediatric inflammatory bowel disease-associated arthropathies.
abstract: Joint involvement is the most common extraintestinal manifestation in children with inflammatory bowel disease (IBD) and may involve 16%-33% of patients at diagnosis or during follow-up. It is possible to distinguish asymmetrical, transitory and migrating arthritis (pauciarticular and polyarticular) and spondyloarthropathy (SpA). Clinical manifestations can be variable, and peripheral arthritis often occurs before gastrointestinal symptoms develop. The inflammatory intestinal pattern is variable, ranging from sub-clinical inflammation conditions, classified as indeterminate colitis and nodular lymphoid hyperplasia of the ileum, to Crohn's disease or ulcerative colitis. Unlike the axial form, there is an association between gut inflammation and evolution of recurrent peripheral articular disease that coincides with a flare-up of intestinal disease. This finding seems to confirm a key role of intestinal inflammation in the pathogenesis of SpA. An association between genetic background and human leukocyte antigen-B27 status is less common in pediatric than n adult populations. Seronegative sacroiliitis and SpA are the most frequent forms of arthropathy in children with IBD. In pediatric patients, a correct therapeutic approach relies on the use of nonsteroidal antiinflammatory drugs, local steroid injections, physiotherapy and anti-tumor necrosis factor therapy (infliximab). Early diagnosis of these manifestations reduces the risk of progression and complications, and as well as increasing the efficacy of the therapy.
authors.affiliation: Sabrina Cardile, Claudio Romano, Department of Pediatrics, University of Messina, 98125 Messina, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Cardile
authors.affiliation: Sabrina Cardile, Claudio Romano, Department of Pediatrics, University of Messina, 98125 Messina, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Romano
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications; D003424:Crohn Disease / Q000150:complications; D018450:Disease Progression; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D012074:Remission Induction; D015398:Signal Transduction; D025242:Spondylarthropathies / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D018836:Inflammation Mediators
keywords: Extraintestinal manifestations; Inflammatory bowel disease; Infliximab; Sacroiliitis; Spondyloarthropathy