Towards the differential diagnosis of joint syndrome: Juvenile idiopathic arthritis and joint lesions in inflammatory bowel disease

A. V. Polyanskaya; S. N. Chebysheva; I. M. Korsunskaya; N. A. Geppe; M. N. Nikolaeva; E. Yu. Afonina; V. A. Seraya; Yu. O. Kostina; E. V. Borisova; E. S. Zholobova; N. V. Aleksakova; M. Yu. Kuzina; Ya. G. Ambartsumova

doi:10.21518/ms2025-393

Towards the differential diagnosis of joint syndrome: Juvenile idiopathic arthritis and joint lesions in inflammatory bowel disease

https://doi.org/10.21518/ms2025-393

Full Text:

PDF (Rus)

Generate QR code

Abstract

Introduction. A range of diseases that require differential diagnostic search in persistent joint syndrome in children include juvenile idiopathic arthritis (JIA) and joint lesions in inflammatory bowel diseases (IBD).

Aim. To analyze and compare the nature of joint syndrome in children with JIA and Crohn’s disease (CD) with joint lesions.

Materials and methods. The joint syndrome was analyzed in a group that included 23 children with JIA and 24 children with Crohn’s disease with joint lesions. Statistical data were processed using parametric tests and exact formulas for percentage-based relationships.

Results. JIA typically affected the knee, ankle, hip, and wrist joints (21 (91.3%), 14 (60.9%), 15 (65.2%), and 5 (21.7%) children, respectively). Enthesopathies were detected in 4 (17.4%) children. CD caused spondyloarthritis in 5 children (10.8%) and peripheral joint lesions in 15 patients (58.3%). Knees, hips, and small joints of the hands and feet were affected most frequently (14 (58.3%), 13 (54.2%), 9 (37.5%), and 4 (16.7%) children, respectively). Enthesopathies were detected in 10 children (41.7%). An analysis of the comparative frequency of joint lesions in JIA and CD showed that the knee, ankle, and wrist joints were significantly more often involved in JIA, while enthesitis were significantly more often detected in CD (p < 0.05). 5 patients (10.8%) had CD-associated spondyloarthritis. Antinuclear antibodies were identified significantly more often in patients with JIA (p < 0.05). The article is also illustrated with two clinical case reports.

Conclusions. The data presented demonstrate differences in the nature of joint syndrome in children with JIA and CD. A detailed history taking, physical examination, and assessment of the nature of the joint syndrome make it possible to establish a correct diagnosis and select a rational approach to the management of patients.

Keywords

extraintestinal manifestations, Crohn’s disease, seronegative spondyloarthropathies, children, juvenile idiopathic arthritis

About the Authors

A. V. Polyanskaya

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Angelina V. Polyanskaya - Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Children’s Diseases, Filatov Clinical Institute of Children’s Health, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

S. N. Chebysheva

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Svetlana N. Chebysheva - Dr. Sci. (Med.), Professor of the Department of Children’s Diseases, Filatov Clinical Institute of Children’s Health, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

I. M. Korsunskaya

Center for Theoretical Problems of Physical and Chemical Pharmacology of Russian Academy of Sciences; Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology
Россия

Irina M. Korsunskaya - Dr. Sci. (Med.), Professor, Head of the Laboratory of Physicochemical and Genetic Problems of Dermatology, Center for Theoretical Problems of Physical and Chemical Pharmacology of Russian Academy of Sciences; Leading Researcher, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology

30, Srednyaya Kalitnikovskaya St., Moscow, 109029; 17, Leninsky Ave., Moscow, 119071

N. A. Geppe

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Natalia A. Geppe - Dr. Sci. (Med.), Professor, Head of the Department of Children’s Diseases, Filatov Clinical Institute of Children’s Health, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

M. N. Nikolaeva

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Maria N. Nikolaeva - Head of the Children's Rheumatology Department No. 1, Sechenov Center for Motherhood and Childhood, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

E. Yu. Afonina

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Elena Yu. Afonina - Doctor of the Children's Rheumatology Department No. 1, Sechenov Center for Motherhood and Childhood, Sechenov First Moscow State Medical University (Sechenov University)

8, Bldg. 2, Trubetskaya St., Moscow, 119991

V. A. Seraya

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Valentina A. Seraya - Rheumatologist of the Children's Rheumatology Department No. 1, Sechenov Center for Motherhood and Childhood, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

Yu. O. Kostina

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Yulya O. Kostina - Doctor of the First Rheumatology Department, Sechenov Center for Motherhood and Childhood, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

E. V. Borisova

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Elena V. Borisova - Head of the Gastroenterology Department, Sechenov Center for Motherhood and Childhood, Sechenov First Moscow State Medical University (Sechenov University)

8, Bldg. 2, Trubetskaya St., Moscow, 119991

E. S. Zholobova

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Elena S. Zholobova - Dr. Sci. (Med.), Professor of the Department of Children’s Diseases, Filatov Clinical Institute of Children’s Health, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

N. V. Aleksakova

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Natalia V. Aleksakova - Head of the Department of Ultrasound Diagnostics, Sechenov Center for Motherhood and Childhood, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

M. Yu. Kuzina

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Marina Yu. Kuzina - Head of the Department of Radiation Diagnostics, Sechenov Center for Motherhood and Childhood, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

Ya. G. Ambartsumova

Sechenov First Moscow State Medical University (Sechenov University)
Россия

Yana G. Ambartsumova - Student, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

References

1. Арлеевская МИ, Сердюк ИЛ, Абдрахманова АИ, Асадуллина ИИ, Елагина ДИ. Боли в суставах: дифференциальная диагностика. Казань: Казан. ун-т; 2023. 61 с. Режим доступа: https://kpfu.ru/staff_files/F1316182992/Metod_posobie.BOLI_V_SUSTAVAKh._DIFFERENCIALNAYa_DIAGNOSTIKA.pdf.

2. Akhunova RR, Akhunova GR. Articular syndrome in clinical practice. RMJ. 2022;(6):42–45. (In Russ.) Available at: https://www.rmj.ru/articles/revmatologiya/Sustavnoy_sindrom_v_klinicheskoy_praktike/.

3. Zotova LA. Modern clinical strategies for differential diagnosis of articular syndrome in rheumatology practice. International Research Journal. 2023;(4). (In Russ.) https://doi.org/10.23670/IRJ.2023.130.21.

4. Алексеева ЕИ, Дворяковская ТМ, Шилькрот ИЮ, Костик ММ, Никишина ИП, Ушакова СА и др. Юношеский артрит: клинические рекомендации. М.; 2025. 308 с. Режим доступа: https://cr.minzdrav.gov.ru/view-cr/477_2.

5. Palman J, Shoop-Worrall S, Hyrich K, McDonagh JE. Update on the epidemiology, risk factors and disease outcomes of Juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol. 2018;32(2):206–222. https://doi.org/10.1016/j.berh.2018.10.004.

6. Thierry S, Fautrel B, Lemelle I, Guillemin F. Prevalence and incidence of juvenile idiopathic arthritis: a systematic review. Joint Bone Spine. 2014;81(2):112–117. https://doi.org/10.1016/j.jbspin.2013.09.003.

7. Smith JA, Burgos-Vargas R. Outcomes in Juvenile-Onset Spondyloarthritis. Front Med. 2021;8:680916. https://doi.org/10.3389/fmed.2021.680916.

8. Alekseeva YeI. Juvenile Idiopathic Arthritis: Clinical Picture, Diagnosis, Treatment. Current Pediatrics. 2015;14(1):78–94. (In Russ.) https://doi.org/10.15690/vsp.v14i1.1266.

9. Petty RE, Laxer RM, Lindsley CB, Wedderburn L, Fuhlbrigge RC, Mellins ED (eds.). Textbook of Pediatric Rheumatology. 8th ed. Philadelphia, PA: Elsevier; 2020. 768 p.

10. Kuzin AV, Rumiantsev VG. Arthritis associated with the inflammatory intestinal diseases. Russian Journal of Evidence-Based Gastroenterology. 2014;3(2):32–35. (In Russ.) Available at: https://www.mediasphera.ru/issues/dokazatelnaya-gastroenterologiya/2014/2/162305-22602015025.

11. Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis. 2011;17(1):423–439. https://doi.org/10.1002/ibd.21349.

12. van Rheenen PF, Aloi M, Assa A, Bronsky J, Escher JC, Fagerberg UL et al. The Medical Management of Paediat-ric Crohn’s Disease: an ECCO-ESPGHAN Guideline Update. J Crohns Colitis. 2021;15(2):jjaa161. https://doi.org/10.1093/ecco-jcc/jjaa161.

13. Баранов АА, Баранова-Намазова ЛС, Разумовский АЮ, Хавкин АИ, Аверкина НА, Аксельров МА и др. Болезнь Крона: клинические рекомендации. М.; 2024. 133 с. Режим доступа: https://cr.minzdrav.gov.ru/view-cr/682_2.

14. Баранов АА, Баранова-Намазова ЛС, Разумовский АЮ, Хавкин АИ, Аверкина НА, Аксельров МА и др. Язвенный колит: клинические рекомендации. М.; 2024. 104 с. Режим доступа: https://cr.minzdrav.gov.ru/view-cr/391_3.

15. Belousova EA, Abdulganieva DI, Alexeeva OP, Alexeenko SA, Baranovsky AYu, Valuyskikh EYu et al. Social and demographic characteristics, Features of disease course and treatment options of inflammatory bowel disease in Russia: results of two multicenter studies. Almanac of Clinical Medicine. 2018;46(5):445–463. (In Russ.) https://doi.org/10.18786/2072-0505-2018-46-5-445-463.

16. Polyanskaya AV, Chebysheva SN, Yablokova EA, Korsunskaya IM, Geppe NA, Borisova EV et al. Challenges in the diagnosis of inflammatory bowel diseases in children: Author’s data and a clinical case. Pediatrics. Consilium Medicum. 2025;(1):101–106. (In Russ.) https://doi.org/10.26442/26586630.2025.1.203124.

17. Yablokova EA, Khavkin AI, Polyanskaya AV, Chebysheva SN, Lokhmatov MM, Erokhina MI, Chibrina EV. Extraintestinal manifestations of inflammatory bowel disease in children: focus on the musculoskeletal system. Clinical Practice in Pediatrics. 2023;18(4):62–72. (In Russ.) https://doi.org/10.20953/1817-7646-2023-4-62-72.

18. Polyanskaya AV, Chebysheva SN, Yablokova EA, Korsunskaya IM, Geppe NA, Borisova EV et al. Joint damage in children with inflammatory bowel diseases – experience of one center. Russian Bulletin of Perinatology and Pediatrics. 2025;70(2):87–92. (In Russ.) https://doi.org/10.21508/1027-4065-2025-70-2-87-92.

19. Erdes ShF. A new concept of spondyloarthritis: a compromise between ASAS and GRAPPA? Rheumatology Science and Practice. 2017;55(6):698–700. (In Russ.) Available at: https://elibrary.ru/ypxrgc.

20. Lukina GV, Knyazev OV, Belousova EA, Abdulganieva DI, Aleksandrova EN, Bakulin IG et al. Russian Cross-disciplinary Consensus on the diagnosis and treatment of spondyloarthritis associated with inflammatory bowel diseases. Terapevticheskii Arkhiv. 2025;97(2):198–213. (In Russ.) https://doi.org/10.26442/00403660.2025.02.203117.

21. Lamot L, Ravelli A. Classification criteria for chronic arthritis in children: a work in progress. ARP Rheumatol. 2022;1(2):107–108. Available at: https://pubmed.ncbi.nlm.nih.gov/35810367/.

22. Petty RE, Laxer RM, Wedderburn LR. Juvenile Idiopathic Arthritis. In: Petty RE, Laxer RM, Lindsley CB, Wedderburn L (eds.). Textbook of Pediatric Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2016, pp. 188–204.e6. https://doi.org/10.1016/B978-0-323-24145-8.00015-6.

23. Martini A, Ravelli A, Avcin T, Beresford MW, Burgos-Vargas R, Cuttica R et al. Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus. J Rheumatol. 2019;46(2):190–197. https://doi.org/10.3899/jrheum.180168.

24. Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68(Suppl. 2):ii1–ii44. https://doi.org/10.1136/ard.2008.104018.

25. Cardile S, Romano C. Current issues in pediatric inflammatory bowel disease-associated arthropathies. World J Gastroenterol. 2014;20(1):45–52. https://doi.org/10.3748/wjg.v20.i1.45.

26. Lukina GV, Kulakova PI, Novikov AA, Savenkova NA, Alexandrova EA, Volnukhin EV, Kovshik AN. Frequency of inflammatory bowel diseases in patients with ankylosing spondylitis. Medical Alphabet. 2019;2(37):12–15. (In Russ.) https://doi.org/10.33667/2078-5631-2019-2-37(412)-12-15.

27. Kuzin AV. Injury to the joint and spinal column in patients with inflammatory bowel diseases. Sovremennaya Revmatologiya. 2016;10(2):78–82. (In Russ.) https://doi.org/10.14412/1996-7012-2016-2-78-82.

28. Akobeng AK. Clinical usefulness of the faecal calprotectin test in suspected paediatric inflammatory bowel disease. Acta Paediatr. 2018;107(11):2019–2023. https://doi.org/10.1111/apa.14374.

29. Lamot L, Miler M, Vukojević R, Vidović M, Lamot M, Trutin I et al. The Increased Levels of Fecal Calprotectin in Children With Active Enthesitis Related Arthritis and MRI Signs of Sacroiliitis: The Results of a Single Center Cross-Sectional Exploratory Study in Juvenile Idiopathic Arthritis Patients. Front Med. 2021;8:650619. https://doi.org/10.3389/fmed.2021.650619.

Review

For citations:

Polyanskaya AV, Chebysheva SN, Korsunskaya IM, Geppe NA, Nikolaeva MN, Afonina EY, Seraya VA, Kostina YO, Borisova EV, Zholobova ES, Aleksakova NV, Kuzina MY, Ambartsumova YG. Towards the differential diagnosis of joint syndrome: Juvenile idiopathic arthritis and joint lesions in inflammatory bowel disease. Meditsinskiy sovet = Medical Council. 2025;(15):182-191. (In Russ.) https://doi.org/10.21518/ms2025-393

JATS XML