Hand splints crohns

[my little penguin]

Anyone have stiffness bad enough in their kiddos joint that hand splints were needed ?
Right now DS only has a dx of crohn's but he does have daily stiffness in his fingers .
Rheumo has us adding resting hand splints at night to try and decrease the stiffness .
Has anyone else has stiff joints with their crohn's ?
He does not have swelling or redness at all
Very confusing .
He still has large joint pain and stiffness but that is rare and moves from joint to joint .
His fingers are stiff every day worse first thing in the morning .
Mystery kiddo keeps us on our toes .

 

[Maya142]

Both my girls have enthesitis (sp?) - inflammation where ligaments meet the bone. So their actual joints won't look swollen but they'll still be stiff and painful. My younger daughter has very stiff fingers in the morning, but we haven't had to deal with splints.
I can PM or email you some good info about spondyloarthropathies (in kids) if you are interested.

 

[my little penguin]

Abstract

Background—Peripheral arthropathy is a well-recognised complication of inflammatory bowel disease (IBD). Little is known of its natural history, but a variety of joint involvement has been described, from large joint pauciarticular arthropathy to a rheumatoid pattern polyarthropathy.
Aims—To classify the peripheral arthropathies according to pattern of articular involvement, and study their natural history and clinical associations.
Methods—The case notes of all patients attending the Oxford IBD clinic were reviewed, and information on general disease characteristics, extraintestinal features, and arthropathy extracted. This was confirmed by direct patient interview using questionnaires at routine follow up. Patients with recorded joint swelling or effusion were classified as type 1 (pauciarticular) if less than five joints were involved and type 2 (polyarticular) if five or more were involved. Patients without evidence of swelling were classified as arthralgia.
Results—In total, 976 patients with ulcerative colitis (UC) and 483 with Crohn’s disease (CD) were reviewed. Type 1 occurred in 3.6% of patients with UC (83% acute and self-limiting) and in 6.0% of those with CD (79% self-limiting); 83% and 76%, respectively, were associated with relapsing IBD. Type 2 occurred in 2.5% of patients with UC and 4.0% of those with CD; 87% and 89%, respectively, caused persistent symptoms whereas only 29% and 42%, respectively, were associated with relapsing IBD.
Conclusion—Enteropathic peripheral arthropathy without axial involvement can be subdivided into a pauciarticular, large joint arthropathy, and a bilateral symmetrical polyarthropathy, each being distinguished by its articular distribution and natural history.
ulcerative colitis Crohn’s disease peripheral arthropathy extraintestinal manifestations
Locomotor complications are well-recognised in both ulcerative colitis and Crohn’s disease. They include peripheral and axial syndromes and are generally considered to be part of the wider group of seronegative spondyloarthropathies,1–3 including idiopathic ankylosing spondylitis, reactive arthritis and psoriatic arthritis.
Idiopathic ankylosing spondylitis is characterised by axial skeletal involvement with ankylosis, but peripheral joint involvement may also occur. It is associated with possession of HLA-B27 in over 90% of cases.4 Ankylosing spondylitis may also complicate inflammatory bowel disease (IBD), but here the strength of the HLA-B27 association is reportedly less (50–70% of cases).5-7Isolated sacroiliitis (which may be asymptomatic) has also been described in IBD, but no association with B27 is recognised in these patients.
The peripheral arthropathies associated with IBD occur in between 5 and 20% of patients8-11 and several patterns of joint involvement have been described, ranging from a large joint pauciarticular arthropathy to a small joint symmetrical polyarthropathy. The proportion of each differs between studies.8-10 They are seronegative and are non-erosive and usually non-deforming, but their clinical course and long term outcome have been poorly characterised.9 12 In addition, no association has been shown between peripheral arthropathies and HLA-B27 in IBD6 13 14 despite apparent similarities between the large joint arthropathy and post-dysenteric reactive arthritis (in which 70% of patients are HLA-B27 positive).15
Oxford, UK, is a major secondary and tertiary referral centre for IBD and has a large patient population. In this study we have identified all patients with peripheral joint symptoms in the absence of axial disease who attend the Oxford IBD clinic. We have studied the natural history of the peripheral joint disease and the associations with other extraintestinal manifestations and bowel disease in relation to pattern of articular involvement. We have analysed the long term history of peripheral joint involvement in IBD.

Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history
Authors
T R Orcharda,
B P Wordsworthb,
D P Jewella
aGastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, UK, bMusculoskeletal Research Unit
Dr Jewell.
Accepted 31 October 1997


from:

http://m.gut.bmj.com/content/42/3/387.full


So maybe the finger "thing" is just a milder version of this.
I just hope the docs can figure " IT" out soon.

 

[Maya142]

Yes, hopefully it won't turn into anything else.
Is your son HLA-B27+? Both my girls are.

 

[my little penguin]

I don't know- since there hasn't been any swelling- everything is from crohn's - so no blood work/imaging etc...for any types of arthritis .
he is being watched very closely by rheumo with followups every few months.

 

[my little penguin]

Articular-peripheral complications and axial involvement occur in 23% and 4%, respectively, of IBD adult patients[4]; in this group, 1 out of 5 shows peripheral arthritis, axial arthritis or both[5,6]. Stawarsky et al[7] carried out an epidemiological study on pediatric IBD patients that confirmed IBD-associated arthropathy in 7%-25% of patients. Although in some studies, there was an increased prevalence of arthritis in the pediatric population compared to adults[8], with female prevalence. In a recent retrospective, prospective study, the phenotypic expression of the disease between patients with childhood-onset IBD (133 pediatric patients) and adulthood-onset (179 adult patients) cases was evaluated, observing that EIMs in pediatric age patients were more frequent (14.3% vs 7.3%) and joint involvement had the same incidence (4.1% vs 4.5%)[9]. Lakatos et al[10] have suggested that in 29% of pediatric IBD there was a risk of developing EIMs within a follow-up period of 15 years. Dotson et al[11] examined the rates of EIMs in a pediatric IBD population, and reported the prevalence of arthralgias (17%), followed by aphthous stomatitis (8%) and arthritis (4%). Furthermore, joint symptoms were correlated with severity and activity of intestinal disease. Orchard et al[12] proposed a classification of enteropathic peripheral arthropathies in adults, distinguishing between Type 1 (pauciarticular, large, inferior articulations) and Type 2 arthritis (polyarticular, small, superior articulations). Type 1 arthritis (4%-17% of patients with Crohn’s disease, CD) is correlated with IBD-activity and affects less than five joints (usually ankles, knees, hips, wrists and, sometimes, elbows and shoulders) with evidence of swelling or effusion. Type 2 (2.5% of patients with CD) follows a course independent of the activity of IBD, with persistent symptoms. Type 1 arthritis is more frequent in adult patients with stenosing and penetrating perianal CD, and twice as frequent in patients with colonic and ileocolonic disease, as opposed to patients with ileal disease. Another form of arthritis has been proposed, type 3 peripheral, which includes patients with both axial involvement and peripheral arthritis.
Axial forms are different, with a clinical course generally independent of IBD activity index, and sacroiliitis (SI) may also be asymptomatic in 50% of patients with CD[13,14]. In ulcerative colitis (UC), articular complications are more frequent in patients with pancolitis, as opposed to patients with proctitis or left-sided UC[15].

World J Gastroenterol. 2014 January 7; 20(1): 45–52.
Published online 2014 January 7. doi: 10.3748/wjg.v20.i1.45
PMCID: PMC3886031
Current issues in pediatric inflammatory bowel disease-associated arthropathies

Sabrina Cardile and Claudio Romano



From:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886031/?report=classic