Artritis como debut de enfermedad inflamatoria intestinal en pediatría / Arthritis as clinical presentation of inflammatory bowel disease in children

La incidencia de enfermedad inflamatoria intestinal en la edad pediátrica se ha incrementado mundialmente en las últimas décadas. La forma de presentación puede ser diversa y, hasta en un 6-35 %, las manifestaciones extraintestinales pueden ser el debut; la artritis periférica es la más frecuente de estas. Una presentación atípica implica un retraso diagnóstico y, asociado a que el fenotipo de enfermedad inflamatoria intestinal es más grave en los niños, conlleva un incremento de las complicaciones intestinales y secuelas asociadas. Se presentan dos casos clínicos de enfermedad de Crohn cuya clínica inicial fue la claudicación de la marcha por una artritis periférica y una entesitis, respectivamente.

Inflammatory bowel disease in children has increased worldwide during the last decades. Clinical presentations are diverse and extraintestinal manifestations are the presenting sign in 6-35 % of patients, the most common of them being peripheral arthritis. An atypical clinical presentation results in diagnosis delay and, added to the greater seriousness of inflammatory bowel disease phenotypes in children, it entails more intestinal complications and sequelae. We describe two cases of inflammatory bowel disease with an initial symptom of lameness due to peripheral arthritis and enthesitis, respectively.

Determining Clinical Risk Factors for Radiographical Severity in Patients with Ankylosing Spondylitis in Daegu and Kyungpook Territories / 대한류마티스학회지

OBJECTIVE: This study was designed to identify prognostic determinants of radiographical severity in patients with ankylosing spondylitis (AS) living in Daegu and Kyungpook territories. METHODS: One hundred-nineteen patients with AS were consecutively enrolled from four regional general hospitals. Clinical data including smoking habits, alcohol intake, disease duration, HLA-B27 positivity, involvement of peripheral joints, occupational activity, and regular exercise were investigated. Radiographical severity was assessed by the Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Statistical analyses were performed using the independent Student's t-test, Pearson's correlation coefficient analysis, and multivariate regression analysis. RESULTS: Radiographical severity, as evaluated with the mSASSS, was associated with age of disease onset (p=0.011) and disease duration (p<0.001). Additionally, mSASSS was significantly higher in males than females (p=0.039) and in patients without involvement of ankle arthritis than those with involvement of ankle arthritis (p=0.026). Patients with hip arthritis had significantly higher mSASSS scores than those without hip arthritis. A multivariate regression analysis showed that older age of disease onset, male gender, and disease duration were independent predictors of AS radiographical severity (p<0.001, p=0.013, and p<0.001, respectively). Hip arthritis was an independent predictor of C-spine radiographical severity in AS (p=0.031). CONCLUSION: Radiographical severity of the prognosis was determined by age of disease onset, gender, and disease duration in patients with AS living in Daegu and Kyungpook territories.

Undifferentiated Spondyloarthropathy in Korea: Focusing on Peripheral Arthritis

Undifferentiated spondyloarthropathy (USpA) includes the forms that do not meet criteria for the established categories of spondyloarthropathy. The clinical spectrum of USpA is therefore wide and few studies have been published on USpA, especially peripheral arthritis. A total of 107 patients fulfilling the European Spondyloarthropathy Study Group criteria for SpA were studied retrospectively by a chart review and interview by a rheumatologist. Peripheral arthritis, excluding hip and shoulder involvement, occurred in 97 of the 107 patients (91%). Joint involvement tended to be monoarticular or pauciarticular, and most frequently developed in peripheral joints including the knee and ankle. Among the 97 patients with peripheral arthritis, only 37 (35%) had a persistent arthritis. HLA-B27 was detected in 80 patients (78%). Peripheral arthritis was found in the lower extremities regardless of symmetry or asymmetry and tended to run a benign course with only a few patients having persistent arthritis

Higher Prevalence of Peripheral Arthritis Among Ankylosing Spondylitis Patients

This study was performed to define the clinical spectrum and disease manifestations of ankylosing spondylitis (AS) in a referral hospital setting. We identified the differences in clinical manifestations according to the sex, the age at onset, the presence of peripheral arthritis and the presence of HLA B27. A total 412 patients (357 males, 55 females) were recruited. Eighty-seven percent were men and 155 out of 412 patients (35%) were juvenile-onset. HLA B27 was detected in 385 patients (93%). Peripheral joint involvement was noted in 287 of total AS cases (juvenile- onset ankylosing spondylitis (JOAS), 82%; adult-onset ankylosing spondylitis (AOAS), 61%), and was more common than those reported in other studies. A greater portion of patients with JOAS had peripheral arthritis and peripheral enthesitis than the patients with AOAS. The patients with peripheral arthritis showed a younger age at onset and an increased tendency of having enthesitis and trauma history. The natural history of Korean AS appears largely similar to those seen in Europe and North America, except a few differences. JOAS was quite common and AS was about nine times more common in men than in women. In addition, the HLA B27 antigen frequency was 93%, which is higher than those reported in other studies.

A Case of Crohn? Disease Associated with Pyoderma Gangrenosum and Peripheral Arthritis / 대한류마티스학회지

The Crohn? disease is a inflammatory bowel disease and it? symptoms are nonspecific. The extraintestinal manifestations of Crohn? disease are arthritis, pericholangitis, erythema nodosum, pyoderma gangrenosum, uveitis, episcleritis, and miscellaneous. Arthritic manifestations caused by Crohn? disease belong to seronegative spondyloarthropathies and are divided into peripheral arthritis, spondylitis, and sacroiliitis. And peripheral arthritis in Crohn? disease usually worsen with exacerbation of bowel inflammation but pyoderma gangrenosum, the most severe skin lesion, bears little relationship to the activity or extent of the colitis. A 53 year-old man presented peripheral arthritis on multiple joints and necrotizing ulcerative skin lesion on abdomen and left knee. He had undergone T-loop colostomy due to recurrent anal fistula. Colonoscopy and biopsy of colonic mucosa showed Crohn? disease. We report a case of Crohn? disease associated with pyoderma gangrenosum and peripheral arthritis with relevant review of literatures.

A Case of Crohn? Disease Associated with Pyoderma Gangrenosum and Peripheral Arthritis / 대한류마티스학회지

The Crohn? disease is a inflammatory bowel disease and it? symptoms are nonspecific. The extraintestinal manifestations of Crohn? disease are arthritis, pericholangitis, erythema nodosum, pyoderma gangrenosum, uveitis, episcleritis, and miscellaneous. Arthritic manifestations caused by Crohn? disease belong to seronegative spondyloarthropathies and are divided into peripheral arthritis, spondylitis, and sacroiliitis. And peripheral arthritis in Crohn? disease usually worsen with exacerbation of bowel inflammation but pyoderma gangrenosum, the most severe skin lesion, bears little relationship to the activity or extent of the colitis. A 53 year-old man presented peripheral arthritis on multiple joints and necrotizing ulcerative skin lesion on abdomen and left knee. He had undergone T-loop colostomy due to recurrent anal fistula. Colonoscopy and biopsy of colonic mucosa showed Crohn? disease. We report a case of Crohn? disease associated with pyoderma gangrenosum and peripheral arthritis with relevant review of literatures.