Journal Article

Musculoskeletal manifestations in children with inflammatory bowel disease: a multicenter cohort study (GASTROREUM study)

La Torre, Francesco, Conti, Giovanni, Pastore, Serena, De Benedetti, Fabrizio, Barone, Patrizia, Floretta, Ilenia, Civitelli, Fortunata, Arrigo, Serena, Mauro, Angela, Cantarini, Luca, Simonini, Gabriele, Lattanzi, Bianca, Magni-Manzoni, Silvia, Vergine, Gianluca, Gattorno, Marco, Olivieri, Alma Nunzia, Mambelli, Lorenzo, Del Giudice, Emanuela, Bovis, Francesca, Miniaci, Angela, Greco, Silvia, Civino, Adele, Montin, Davide, Cappella, Michela, Gallizzi, Romina, Sacco, Emanuela, Filocamo, Giovanni, Taurisano, Manuela, Ravelli, Angelo, Tarantino, Giusyda, Diomeda, Federico, Campus, Simona, Greco, Rossella, Maggio, Maria Cristina

2025

Overview

Background Musculoskeletal (MSK) symptoms are the most common extra-articular manifestations of pediatric-onset inflammatory bowel diseases (pIBD), and are associated with a more aggressive disease course. This study aims to characterize MSK manifestations in patients with pIBD, and to seek for predictors of persistently active arthritis one year after pIBD diagnosis. Methods A multicenter, retrospective cohort study was conducted at 25 Italian pediatric rheumatology centers. Patients aged < 18 years with pIBD and MSK manifestations, followed for at least one year, were included. Data at onset of first MSK symptom, pIBD diagnosis, and one-year follow-up visit following pIBD diagnosis were collected. Results A total of 180 patients were included, 111 (61.7%) with Crohn’s disease (CD), 55 (30.5%) with ulcerative colitis (UC), and 14 (7.8%) with unclassified IBD (IBDU). Arthralgia (72.8%) and arthritis (69.4%), were the most frequent MSK manifestations. Patients with CD had MSK symptoms prior to pIBD diagnosis more frequently than those with UC/IBDU (51.4% vs. 40.6%). Among the 125 patients with arthritis, 76.8% had peripheral arthritis, 14.4% had axial disease, and 8.8% had both peripheral and axial involvement. The most common articular pattern was oligoarthritis (52.0%), followed by monoarthritis (26.4%) and polyarthritis (21.6%). The most frequently affected joints were the knee, ankle, and hip . On multivariable analysis, antinuclear antibody (ANA) positivity (OR = 3.05, 95% CI: 1.05 – 8.89) and a polyarticular course of arthritis (OR = 3.42, 95% CI: 1.13–10.38) were independently associated with persistence of active arthritis at year 1 after pIBD diagnosis. Conclusions Most patients with pIBD and arthritis presented with peripheral oligoarthritis affecting lower limb joints. A positive ANA status and development of polyarthritis predicted sustained arthritis activity.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adalimumab / Adolescent / Arthralgia - etiology / Arthritis / Arthritis - etiology / Autoantibodies / Back pain / Child / Children / Cohort analysis / Colitis, Ulcerative - complications / Crohn Disease - complications / Diseases / Endoscopy / Family medical history / Female / Gastrointestinal diseases / Humans / Inflammation / Inflammatory bowel disease / Inflammatory Bowel Diseases - complications / Italy - epidemiology / Juvenile idiopathic arthritis / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Musculoskeletal / Musculoskeletal Diseases - etiology / Patients / Pediatrics / Psoriasis / Remission (Medicine) / Retrospective Studies / Rheumatology / Sacroiliitis