PERINATOLOGIYA AND PEDIATRIYA.2019.1(77):85-91; doi 10.15574/PP.2019.77.85

Oshlyanska O. A., Berezenko V. S., Nadtochiy T. G., Doroshenko A. O., Artzymovich A. G., Krat V. V.
Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
SI «Institute of Pediatrics, Obstetrics and Gynecology named of academician O.M. Lukyanova NAMS of Ukraine», Kyiv
Bogomolets National Medical University, Kyiv, Ukraine

Inflammatory bowel disease is a group of chronic diseases that are characterized by destructive nonspecific immune inflammation of the intestinal wall, the main forms include Crohn's disease and ulcerative colitis. Particular attention should be paid to extra-intestinal manifestations, which may occur in patients with IBD simultaneously with signs of intestinal lesions, and in some cases even dominate the clinical picture. The frequency of joint damage in children with inflammatory diseases in comparison with the frequency of immune-mediated lesions of the gastrointestinal tract in patients with juvenile idiopathic arthritis are evaluated in the article. Among the children observed with a diagnosis of «Juvenile idiopathic arthritis», 4.27% showed clinical signs of gastrointestinal lesions. Since a part of JIA sub-variants are pathogenetically close to IBD, it can be assumed that the discrepancy between the prevalence of IBD in children is due to the masking of their extraintestinal manifestations. In cases where the manifestations of articular syndrome precede intestinal lesions, such patients are observed for a long time as diseased entesitis-arthritis. In cases where the manifestations of articular syndrome precede intestinal lesions, such patients are observed for a long time as diseased entesitis-arthritis. In about a third of children with established diagnosis of IBD articular syndrome was observed mainly in the form of arthralgia, only 7.5% had clinical manifestations (edema, tenderness, impaired function, joint pain) and instrumental manifestations of arthritis. In 2 patients, articular syndrome preceded the occurrence of complaints from the gastrointestinal tract. The underestimation of the severity of extraintestinal manifestations artificially lowers the degree of activity of the inflammatory process in IBD, which can lead to serious consequences. The peculiarities of the course, diagnosis and therapy of a disease with severe defeat of the gastrointestinal tract and joints in a child with Crohn's disease are analyzed. Patients with IBD and articular syndrome should be prescribed as early as possible treatment with genetically engineered drugs of biological action, which may provide an opportunity to prevent serious complications and preserve the quality of later life of sick children.

Key words: children, іnflammatory bowel disease, arthritis.

REFERENCES

1. Zapalni zakhvoriuvannia kyshechnyku: ekspertna dumka ta praktychni aspekty. URL: http://health-ua.com/article/37806-zapaln-zahvoryuvannya-kishechniku-ekspertna-dumka-ta-praktichn-aspekti.

2. Kriuchko TO, Nesina IM, Poda OA, Kolenko IO. (2016). Alhorytm dyferentsiinoi diahnostyky zakhvoriuvan kyshechnyka u ditei. Dytiachyi likar. 3(48): 21–24.

3. Omelchenko LI. (2014). Osoblyvosti patomorfozu ta suchasnoho perebihu yuvenilnoho revmatoidnoho artrytu. Zdorove Ukrayni. 1(28). Zdorove Ukrayni. 2(29).

4. Svintsitskyi AS. (2015). Enteropatychni artryty: suchasnyi pohliad na problemu. Kardyolohyia. Revmatolohyia. Kardyokhyrurhyia. 5(30): 67–68.

5. Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy. Zapalni zakhvoriuvannia kyshechnyka (khvoroba krona, vyrazkovyi kolit). Nakaz MOZ Ukrainy vid 11.02.2016 № 90. — URL: http://mtd.dec.gov.ua/images/dodatki/2016_90_Krona/2016_90_YKPMD_Kron.pdf

6. Unyfytsyrovanni klynycheskyi protokol medytsynskoi pomoshchy detiam, bolnыm yuvenylnim artrytom (2012). Zdorove Ukrayni. 4(23).

7. An Overview of Enteropathic Arthritis. Joint Symptoms Combined With Gastrointestinal Problems. URL: https://www.verywellhealth.com/enteropathic-arthritis-the-basic-facts-190442.

8. Baumgart DC. (2017). Crohn's Disease and Ulcerative Colitis, From Epidemiology and Immunobiology to a Rational Diagnostic and Therapeutic Approach: 695.

9. Cheifetz AS. (2017). Treatment of Inflammatory Bowel Disease with Biologics: 335. URL: https://play.google.com/store/books/details?id=bu09DwAAQBAJ&source=ge-web-app. https://doi.org/10.1007/978-3-319-60276-9

10. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. (2014). Journal of Сrohn's Сolitis. 8: 1179–1207. URL: http://www.spgp.pt/media/1068/pdf7.pdf.

11. Hochberg МС. (2018). Rheumatology: 1808. URL: https://play.google.com/books/reader?id=MQBGDwAAQBAJ&hl=uk&printsec =front-cover&source=gbs_atb_hover&pg=GBS.PP1&fbclid=IwAR2gR5H_LxnegtneGO_ybmy_bZl_7dAe3SgR3j3QK0vmM_l7hTN-gF2yUg.

12. Levine JS, Burakoff R. (2011). Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Hepatol. 7: 235–241.

13. Overview of Enteropathic Arthritis. Arthritis Associated With Inflammatory Bowel Disease. — URL: www.spondylitis.org/Enteropathic-Arthritis.

14. Peter M. (2017). Pediatric Inflammatory Bowel Disease: 754. URL: https://books.google.com.ua/books?id=Au8mDwAAQBAJ&printsec=frontcover&hl=uk&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false.

15. Salvarani C, Fries W, Gastroenterol WJ. (2009). Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease. 15: 2449–2455. https://doi.org/10.3748/wjg.15.2449; PMid:19468993 PMCid:PMC2686901

Article received: Oct 30, 2018. Accepted for publication: Mar 11, 2019.