Clinical Significance of Magnetic Resonance Enterography Detected Sacroiliitis in Pediatric Crohn’s Disease: A Retrospective Cohort Study

Objectives The musculoskeletal (MSK) system is the most frequent extraintestinal manifestation (EIM) in Crohn’s disease (CD).[1] One pediatric study has reported on asymptomatic sacroiliitis (SI) in pediatric inflammatory bowel disease (pIBD), detecting this in 15% (5/34).[2] MSK EIMs can have a serious impact on patients’ quality of life and are associated with increased severity of bowel disease activity in pIBD.[3] Given the paucity of literature on this topic, we aim to describe the prevalence of asymptomatic SI and its relationship to clinical characteristics, bowel disease phenotype, intestinal disease activity scores, biomarkers, and other EIMs of disease. Methods In this single-center, retrospective cohort study, data were collected from newly diagnosed (<1 year) pediatric CD patients who had undergone magnetic resonance enterography (MRE) at Children’s Hospital, London Health Sciences Centre over 4 years (2019-2023). Subjects were excluded if the sacroiliac joints were unable to be adequately assessed by the radiologist or if the patient had a previously known diagnosis of spondyloarthritis. Coronal T1, axial T2, and coronal T2W sequences with fat suppression of the MREs were evaluated by an MSK-trained radiologist, with a secondary read by a pediatric-trained MSK radiologist (25% of the cases) to establish inter-rater reliability. Descriptive statistics were used to describe baseline characteristics and group comparisons. Results Among 135 patients with CD who underwent MRE, 10 patients (7.4%) showed evidence of SI on MRE. Patients were sub-categorized as acute SI (2.2%), chronic SI (3%), and acute on chronic SI (2.2%) (Table 1). Half of the patients with evidence of SI on MRE had evidence of inflammatory MSK manifestations. Patients with SI had higher frequency of arthralgia (p-value 0.033), joint swelling (p-value 0.039), and enthesitis (p-value 0.019). There were no significant differences in symptoms of back pain, neither mechanical nor inflammatory. Patients with SI did have significantly higher Simple Endoscopic Scores-CD at initial scope assessment compared to those without (p-value 0.006). Table 1: Clinical characteristics of pediatric Crohn’s disease patients with magnetic resonance enterography imaging. Conclusion Among newly diagnosed pediatric CD patients who underwent MRE examination, 7.4% were identified to have SI. Patients with CD and SI were more likely to report other MSK symptoms and had higher CD endoscopic scores. Limitations of this study include the lack of systematic rheumatology assessment of CD patients for MSK signs/symptoms. Further analyses are planned to evaluate the bowel disease outcomes in patients with SI over time. [1.] Ali A. ACR Open Rheumatol 2022;4(6):547-54. [2.] Giani T. Pediatr Rheumatol 2020;18(1):1-6. [3.] Derfalvi B. Pediatr Rheumatol 2022;20(1):1-9.

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