The Prevalence of Inflammatory Bowel Disease in Juvenile Spondyloarthritis
Ipek Ulkersoy , Umit Gul , Mehmet Yildiz , Arlin Tunc , Sevval Ozyildirim , Nergis Akay , Oguzhan Tin , Nursena Kologlu Ates , Elif Kilic Konte , Aybuke Gunalp , Esma Aslan , Ayse Kalyoncu Ucar , Sezgin Sahin , Nuray Kepil , Kenan Barut , Omer Faruk Beser , Sebuh Kurugoglu , Fugen Cullu Cokugras , Ozgur Kasapcopur
Journal of Digestive Diseases ›› 2025, Vol. 26 ›› Issue (11-12) : 518 -529.
Objectives: Juvenile spondyloarthritis (JSpA) shares genetic, immunopathogenic, and environmental features with pediatric inflammatory bowel disease (IBD), placing patients at an elevated risk for IBD. We aimed to evaluate the prevalence of IBD and identify potential early markers for its recognition in children with JSpA, trying to improve its diagnostic, screening, and treatment strategies.
Methods: Children diagnosed with JSpA were prospectively evaluated. Fecal calprotectin (FCP) was measured in all participants, and those with elevated FCP (> 100 μg/g) or two or more IBD-related symptoms (chronic diarrhea, weight loss/growth retardation, abdominal pain, or bloody/mucous stool) underwent ileocolonoscopy with histopathological and radiological assessment.
Results: Altogether 81 children (71.6% male) with a mean age of 194 months at adimission were included, and 23 underwent endoscopic evaluation (19 for elevated FCP, 4 for two or more IBD-related symptoms). Among them, 10 (43.5%) had both macroscopic and microscopic presentation of colitis, 4 (17.4%) had microscopic appearance only, and 9 (39.1%) had normal histopathological findings. Notably, 94.7% of children with elevated FCP levels were asymptomatic for IBD. Among FCP-positive patients, 13 (68.4%) showed macroscopic and/or microscopic mucosal changes. Overall, colitis was confirmed in 14 (17.3%) patients. Sacroiliitis, as confirmed by magnetic resonance imaging, was significantly more frequent among both FCP-positive and colitis-positive patients (p < 0.001 and p = 0.008, respectively). No significant associations were found between FCP levels or intestinal inflammation and disease activity, acute-phase reactants, or treatment status.
Conclusions: IBD and subclinical colitis are relatively frequent in JSpA. Elevated FCP represents a promising noninvasive biomarker for detecting silent intestinal inflammation, warranting confirmation by ileocolonoscopy.
colitis / fecal calprotectin / inflammatory bowel diseases / juvenile spondyloarthritis / screening
2026 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.
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