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

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. 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. 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. 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.

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Journal
Pediatric Rheumatology
Published
2025-10-10
DOI
https://doi.org/10.1186/s12969-025-01141-z
Primary Topic
Autoimmune and Inflammatory Disorders Research
Type
article
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article

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

Giovanni Filocamo, Romina Gallizzi, Adele Civino, Angela Miniaci et al.
Pediatric Rheumatology
Autoimmune and Inflammatory Disorders Research
article

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

Giovanni Filocamo, Romina Gallizzi, Adele Civino, Angela Miniaci, Chiara Longo, Lorenzo Mambelli, Cecilia Lugarà, Silvia Magni‐Manzoni, Bianca Lattanzi, Valeria Dell’Omo, Francesca Bovis, Maria Francesca Gicchino, Federico Diomeda, Emanuela Del Giudice, Emanuela Sacco, Alessandra Spagnolo, Fortunata Civitelli, Andrea Taddio, Ilaria Battagliere, G Tarantino, Federica Ferrari, Alessandro De Fanti, Pierandrea Elefante, Maria Noemy Pastore, Luca Cantarini, Riccardo Lubrano, Giovanni Conti, Giulia Loiacono, Gianluca Vergine, Angela Mauro, Francesco Chiarelli, Arianna Petrillo, Davide Montin, Marco Gattorno, Francesca Soscia, Edoardo Marrani, F. Cavataio, Fabrizio De Benedetti, Elisabetta Cortis, Rosaria Celano, Michela Cappella, Federica D’Amico, Serena Pastore, Eleonora Del Prete, Serena Arrigo, Ilenia Floretta, Manuela Taurisano, Francesco La Torre, Gabriele Simonini, Maria Cristina Maggio, Alma Nunzia Olivieri, Angelo Ravelli, Patrizia Barone, Simona Campus, Rossella Greco, Francesca Ardenti Morini, S Greco
article en

Abstract

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. 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. 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. 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.

Pediatric RheumatologyVol. 23(1)
University of Salento (IT), University of Trento (IT), IRCCS Materno Infantile Burlo Garofolo (IT), Casa Sollievo della Sofferenza (IT), Istituto Giannina Gaslini (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), University of Chieti-Pescara (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Ospedale "Santa Maria delle Croci" di Ravenna (IT), Ospedale Santa Maria alle Scotte (IT), Ospedali Riuniti di Ancona (IT), Azienda Ospedaliero Universitaria Ospedali Riuniti (IT), Provincia Autonoma di Trento (IT), Meyer Children's Hospital (IT), Ospedale Santa Maria (IT), Azienda USL di Bologna (IT), Bambino Gesù Children's Hospital (IT), Ospedale Microcitemico (IT), University of Campania "Luigi Vanvitelli" (IT), Ospedale Infermi di Rimini (IT), Policlinico Universitario di Catania (IT), Azienda Ospedaliera Universitaria Università degli Studi della Campania Luigi Vanvitelli (IT), Azienda Ospedaliero-Universitaria "Renato Dulbecco" (IT), Azienda Ospedaliera Universitaria Policlinico "G. Martino" (IT), Ospedale Santa Maria Goretti (IT), Ospedale dei Bambini Vittore Buzzi (IT), Ospedale Pediatrico Giovanni XXIII (IT), St. Eugenio Hospital (IT), Ospedale Vito Fazzi (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), ASST Fatebenefratelli Sacco (IT), University of Bari Aldo Moro (IT), University of Genoa (IT)
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Autoimmune and Inflammatory Disorders Research
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