Campoverde-Arévalo BP, Del Valle-Guerra Vilca J, Aldean-Riofrío JR, Loor-Chavez R

Language: Spanish
References: 12
Page: 97-101
PDF size: 405.47 Kb.

ABSTRACT

Introduction: Enthesitis-related arthritis is a rare disorder in the pediatric population, representing between 15 and 20% of juvenile arthritis. In children, unlike in adults, lower limb oligoarthritis, enthesitis and HLA B27 positivity are characteristic in children under 16 years of age. There may be extra-articular manifestations, but it is very rare that they begin with intestinal manifestations without other accompanying symptoms.
Clinical case: A 10-year-old girl evaluated for chronic symptoms of constipation, pain and abdominal distension of 1 year of evolution, father and paternal uncle with a history of ankylosing spondylitis. The abdominal ultrasound reflected a generalized intestinal wall thickening of ileal predominance, this led to the suspicion of autoim mune intestinal pathology, and treatment of the most frequent diseases for the age was initiated through laboratory, office and colonoscopy examinations. The positivity of HLA B27, together with the appearance of arthritis of the carpus, knees and ankles, as well as enthesitis at the achilles level and in the metatarsal heads were key for its diagnosis. A full dose of prednisone and sulfasalazine was started for 12 weeks without improvement of the disease, so it was decided to start biological therapy with anti-TNF (etanercept), presenting a clear improvement in the condition.
Conclusions: The clinical case demonstrates the unusual presentation of intestinal involvement that precedes joint manifestations in enthesitis-related arthritis. It is important to study difficult-to-manage pain, abdominal distension and chronic constipation, through a detailed investigation of the anamnesis and more specific imaging studies to assess the intestine.

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