The significance of ultrasound examination in arthropathies in patients with inflammatory bowel disease: focus on paediatric practice

Background. Inflammatory bowel disease is a chronic immune-inflammatory disease with intestinal and extraintestinal manifestations. Among the extraintestinal manifestations of inflammatory bowel disease, one of the most common is musculoskeletal involvement, which proceeds in the form of seronegative spondyloarthropathies. The involvement of joints in the pathological process affects the functional state and quality of life of the child and requires changes in the scope of therapeutic measures, therefore early diagnosis of the condition of joints and ligaments is of great importance. The non-specific nature of the symptoms and the high frequency of subclinical inflammation in the joints in inflammatory bowel disease make ultrasound examination particularly important as a method of early and safe visualisation of inflammatory changes. Objective. The aim of the study was to analyse the nature of ultrasonic changes in the joints of children with arthropathies associated with Crohn's disease. Materials and methods. The study included 28 children with Crohn's disease and inflammatory bowel disease in the form of joint damage, with a mean age of 11.77 ± 1.45 (95% confidence interval [10.12; 13.12]) years. The diagnosis of Crohn's disease was established in accordance with the Clinical Guidelines for Crohn's disease in Paediatric Patients, 2024. A clinical analysis of joint involvement options was performed; enthesitis was assessed using the MASES index. Arthrosonography was performed on 154 joints of various locations. The study was conducted using a Voluson E8 expert-class ultrasound machine with a linear transducer with a frequency of 6-15 MHz. Ultrasound signs of joint damage were assessed according to the following characteristics: reduction in hyaline cartilage thickness, effusion in the joint capsules (homogeneous/heterogeneous), thickening of the synovial membrane. Quantitative indicators are presented as M ± SD (mean ± standard deviation) with 95% confidence intervals. Qualitative variables are described using absolute and relative (%) frequencies. Student's t-distribution was used to calculate the confidence intervals of the mean values. Results. In our group of 28 children with Crohn's disease, boys predominated – 18/28 (64.3%), while girls accounted for 10/28 (35.7%). The average age of onset was 8.46 ± 1.33 (95% confidence interval [7.13; 9.79]) years. Joint syndrome in 6/28 (21.4%) children was represented by spondyloarthritis, in 14/28 (50%) by oligoarthritis, and in 8/28 (28.6%) by polyarthritis. Physical examination of 28 children revealed changes in 67 joints in the form of effusion/proliferative component. Enthesopathic syndrome was present in 12/28 (42.9%) children, with a mean MASES index of 2.21 ± 2.81 (95% confidence interval [1.12; 3.30]). Arthrosonography was performed on 154 joints of various locations. The most common joint change on ultrasound was synovitis (116/154, 75.3%), with minimal synovitis in 75/116 (64.7%) cases and significant synovitis in 37/116 (31.9%) cases. Diffuse thickening of the synovial membrane was detected in 116 joints (116/154, 75.3%). Only in 2/154 (1.3%) joints was there thinning and unevenness of the cartilage contour. Tenosynovitis was detected in 8/154 (5.2%) cases, and Achilles bursitis in 2/154 (1.3%) cases. Conclusion. In our study, the clinically detectable number of affected joints was 67, while arthrosonography revealed pathological changes in 154 joints, in most patients (65%) mainly in the form of minimal synovitis. Thus, subclinical joint inflammation in children with inflammatory bowel disease occurs much more frequently than is determined by physical examination of patients. The introduction of ultrasound as a screening tool, as well as in the complex dynamic observation of children with inflammatory bowel disease, can contribute to the early detection of inflammatory changes in the joints and the timely optimisation of treatment tactics.