Background: Musculoskeletal involvement occurs in 25% of patients with IBD. Data in the pediatric population are scarce.
Purpose: to compare pediatric IBD patients initially presenting with arthritis, to patients with arthritis of other etiologies, in order to identify clinical and laboratory red flags that may arouse suspicion of IBD.
Methods: This retrospective cohort study included patients followed up at Schneider`s Medical Center between 1985-2016. Clinical and laboratory data of Children with IBD who presented with arthritis (23) were compared to control group (21 JIA, 7 FMF and 18 postinfectious arthritis). Fisher’s exact test, χ² and analysis of variance were used.
Results: The most significant clinical factor which predicted IBD was Sacroiliitis (34.8% vs. 2.2% in controls, P<0.001), and was more common in females (46.15% vs. 20%, p=0.37). The IBD group showed decreased Hemoglobin and MCV levels and elevated RDW (10.5, 69.1, 14.9 vs. 12.0, 79.1, 13.2, P<0.001). Albumin mean values were lower in the IBD group (3.5 vs. 4.3, P<0.001). Despite presence of GI symptoms upon direct questioning, only 26% of children were diagnosed with IBD at the first month after arthritis presentation and 26% were diagnosed at a delay of >1 year. The overall mean time from arthritis presentation to IBD diagnosis was 1.07±1.78 years, up to 7 years delay in IBD diagnosis.
Conclusion: Arthritis, specifically sacroiliitis, associated with microcytic anemia and/or hypoalbuminemia in children without specific signs of IBD should be considered red flags, and arouse suspicion for this disease, thus mandating thorough enquiry.
