Articular syndrome as a manifestation of inflammatory bowel disease: a clinical case

Background: Inflammatory bowel disease (IBD) is a pressing problem in pediatrics. Crohn’s disease (CD) and ulcerative colitis (UC) are characterized by both classic intestinal symptoms and a wide range of extraintestinal manifestations: lesions of skin, oral mucosa, liver, joints. The literature provides various data on the incidence of articular syndrome (AS) in children with IBD: AS in CD is observed in 4–49% of cases, and in UC – in 2–50% of patients. According to our retrospective analysis of 80 case histories, AS was observed in 14 (17.5%) cases, including 10 children with UC and 4 patients with CD.

Description of a clinical case: The article describes a clinical case of late verification of CD in an adolescent with long-term AS and multiple attempts at unsuccessful treatment of arthropathy. For three years, the patient was followed-up by a traumatologist-orthopedist and rheumatologist with complaints of pain in the knee joints, increasing on exertion. Treatment of AS led to temporary relief of symptoms with subsequent development of a relapse. It was possible to suspect and establish the diagnosis of CD only after the manifestation of intestinal syndrome in the form of persistent diarrhea for more than 6 months and recurrent aphthous stomatitis. AS was relieved only after the use of mesalazine and azathioprine, i.e. drugs used to treat the underlying disease.

Conclusion: Given the clinical polymorphism of IBD, pediatricians should be wary of possible extraintestinal manifestations, especially in cases of combination with intestinal symptoms, protein-energy malnutrition and refractoriness to therapy. Thus, the high incidence of AS in IBD, the ineffectiveness of standard therapy for AS emphasize the importance of raising the awareness of pediatricians, as well as rheumatologists and traumatologists-orthopedists.