Current issues in pediatric inflammatory bowel disease-associated arthropathies

Table 1 Classification of spondyloarthropathies

Spondyloarthropathies: Five major subtypes

Ankylosing spondylitis (AS)

Reactive arthritis (ReA)

Psoriatic arthritis

Enteropathic arthritis or arthritis associated with inflammatory bowel disease

Undifferentiated spondyloarthropathy

European spondyloarthropathy study group

Classification criteria for spondyloarthropathy

Inflammatory spinal pain OR synovitis (asymmetrical or predominantly in the lower limbs) plus any one or more of the following:

Positive family history

Alternate buttock pain

Psoriasis

Enthesopathy

Inflammatory bowel disease

Sacroiliitis

Modified New York criteria for the diagnosis of ankylosing spondylitis

Unilateral sacroiliitis grade 3 or 4, or bilateral sacroiliitis grade 2 to 4 together with at least one of the following:

Low back pain of at least three months’ duration improved by exercise and not relieved by rest

Limited motion of lumbar spine in sagittal and frontal planes

Decreased chest expansion relative to normal values for age and sex

Musculoskeletal manifestations of spondylarthropathies

Peripheral arthritis: one or more swollen and tender joint (s); synovitis is asymmetric and predominantly in lower limbs

Inflammatory spinal pain: symptoms of back pain in lumbar, dorsal or cervical regions associated with at least four of the following: (Calin’s criteria)

Onset before age 45 yr

Insidious onset

Improved by exercise

Associated with morning stiffness

Duration of at least three months

Dactylitis: evidence of “sausage digit” on examination

Peripheral enthesitis: achilles tendinitis and/or plantar fasciitis

Buttock pain

Anterior chest wall pain

Table 2 European Crohn’s and colitis organization recommendations

Peripheral arthritis: Short term treatment with non-steroidal anti-inflammatory agents, local steroid injections and physiotherapy (primary focus for underlying Crohn’s disease)

Persistent peripheral arthritis: Sulfasalazine

Axial arthropathy: Intensive physiotherapy associated with non steroidal anti inflammatory drugs

Ankylosing spondylitis and Crohn’s disease intolerant or refractory to non steroidal anti inflammatory drugs: Anti-tumour necrosis factor therapy