Background/Purpose: The incidence of arthritis and arthralgia in pediatric patients with Crohn’s disease (CD) is reported to be 2–15% and 22%, respectively. The aim of our study was to assess joint involvement with Pediatric CD Activity Index (PCDAI) and to assess quality of life (IMPACT-III). While arthritis in pediatric Crohn’s disease is associated with the enthesitis-related JIA subgroup, subclinical sacroiliitis and HLA-B27-association may also be found.

Methods: A cross-sectional study was conducted in 82 pediatric patients with CD (age: 13.7±3.2 years, male:female ratio = 1.2:1, disease duration: 21.6±21, median: 15 months) to assess the prevalence of arthritis, lower extremity enthesitis and arthralgia. Detailed joint physical examination and a modified JAMAR (Juvenile Arthritis Multidimensional Assessment Report) were performed by a pediatric rheumatologist. Regarding disease activity, a PCDAI, IMPACT-III questionnaire and basic laboratory parameters including CRP and platelet count were determined, as well as sacroiliac MRI (n=62) and molecular genetic testing for HLA-B27 (n=72) were assessed.

Results: Altogether 35% (29/82) of the patients had arthritis. At the time of the examination, only 1 child had active enthesitis, 8/29 children had active arthritis indicated by swollen joint(s) – including 4 patients with also restricted range of motion in one or more other joints, suggestive of previous arthritis. Another 15/29 children had evidence of previous arthritis on joint examination. Another 5 patients had a remote history of documented active arthritis. Hip (12/29) and knee (11/29) joints were most commonly affected. Cumulative incidence of arthralgia during the entire course of the disease was 48% (39/82), of whom 22% (18/39) had arthralgia, without arthritis, usually affecting the knee. There was a significant association between arthritis and lower quality of life (IMPACT-III score, p < 0.01). In addition, incidence of arthritis and arthralgia correlated with higher CRP and PCDAI independent of age and sex. Arthritis was significantly more common in patients requiring infliximab treatment. None of the patients had sacroiliitis based on MRI, and HLA-B27 positivity was not related to arthritis.

Conclusion: The prevalence of joint involvement such as arthritis and arthralgia in pediatric CD was higher than previously reported when assessment is done by a pediatric rheumatologist. Arthritis was associated with more severe disease, as reflected by higher CRP, PCDAI score, as well as lower quality of life. Enthesitis was uncommon and sacroiliitis and HLA-B27 positivity were not significant associations in our pediatric CD cohort.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/joint-involvement-in-pediatric-crohns-disease-is-related-to-higher-disease-activity-and-worse-quality-of-life/