No abstract

No abstract

No abstract

BackgroundJoint involvement is the most common extraintestinal manifestation in children with inflammatory bowel disease and it may appear years before its diagnosis.ObjectivesTo describe the characteristics of arthritis associated with inflammatory bowel disease (IBD) in children.MethodsA retrospective, cross sectional, descriptive study was performed including patients of two Pediatric Rheumatology Units from tertiary hospitals with arthritis as the first manifestation of an inflammatory bowel disease.ResultsData for all JIA patients controlled in 2 tertiary centers were analyzed. 14 patients met the inclusion criteria (10 females/4 males). Median age of onset of joint manifestation was 7 years (3–14.3 years). Median age of onset of gastrointestinal symptoms was 17.1 years (8.8–29.8 years). Musculoskeletal manifestations preceded the intestinal manifestations about 12 years (0.3–21.8 years). Most frequent JIA subtype was extended/persistent oligoarticular form (36% of all cases). Polyarticular type of JIA was present in 3 patient, enthesitis related arthritis in 2 patients and undifferentiated JIA in 2 patients. One patient had reactive arthritis. The most common type of IBD was Crohn's disease (60%). The most frequently affected joint was the knee (57%). In 2 patients the initial affected joint was the hip. ANA were positive in 6 children (40%) and 3 had HLA B27 positive (20%). Fecal calprotectin was normal in 10 patients studied. All patients have received systemic corticosteroids and 70% needed articular infiltration. 85% of patients required biological treatment to control the articular symptoms and/or gastrointestinal (mostly adalimumab) associated with DMARDs in a high percentage.ConclusionsIt isn't common that the joint involvement precede the digestive symptoms in IBD. In our series the most frequent category was the oligoarticular form with negative ANA and this presented later than usual. They present an evolution with difficult control of the flares. A large number of patients needed biological treatment to control the articular manifestations. These results support the need for new biomarkers that could detect subclinical intestinal disease in children.Disclosure of InterestNone declared

BackgroundThe potential of expanded flow cytometric analysis of PBLs has not been yet been fully exploited to study JIA heterogeneity neither to monitor JIA patients' on biological treatmentsObjectivesTo analyze in depth lymphocyte subpopulations in treated JIA patients stratified by age and gender.MethodsOne hundred one patients, 69 children and 32 adult fulfilling JIA (ILAR) criteria attending HUVH rheumatology clinic were included. All patients were treated with either MTX, anti-TNFα, or a combination of both. Controls were sex/age matched volunteers either healthy or attending the clinics of HUVH for non inflammatory conditions (59 controls, 29 paediatric and 30 adult). Extended immunophenotype following FITMaN protocol that discerns 57 peripheral blood lymphocyte (PBL) subpopulations was applied. Bonferrroni's correction indicated that the cut off for significance was p<0.00041667.ResultsChanges common to each group of patients irrespective of treatment are as follows: paediatric patients showed lower percentage of CD8 effector cells (CD45RA+CCR7-) when compared to controls (10.53±5.71 vs 16.92±5.71). Percentage of total CD4 cells was higher on JIA children than in controls (42.21±7.40 vs 36.04±5.22). No differences were found on percentages nor in absolute number of Th1 (CXCR3+CCR6-), Th2 (CXCR3-CCR6-), or Th17 (CXCR3-CCR6-) CD4 cells. Interestingly all Th subpopulations showed decreased expression of HLA-DR in JIA children when compared with controls (6.06±3.08 vs 10.49±5.02; 0.81±0.51 vs 1.48±0.64; 8.57±3.81 vs 12.6±4.95; respectively). JIA adults presented no significant differences in T cells subpopulations compared to adult controls, but showed higher percentage of CD21- switch-memory B cells (IgD-IgM-CD27-) than controls (10.82±5.33 vs 4.29±4.33).In a second analysis of the JIA patients few differences were observed according to the administered therapy. Paediatric patients treated with MTX (n=27) showed a lower proportion of the effector memory (CD45RA-CCR7-) cells both CD4+ and CD8+, when compared to controls, anti-TNF, and anti-TNF plus MTX groups (20.01±7.76 vs 27.64±9.27; 20.01±7.76 vs 27.84±4.27; 20.01±7.76 vs 27.07±10.05; for CD4s and 26.42±7.23 vs 37.10±12.38; 26.42±7.23 vs 42.08±11.59; 26.42±7.23 vs 37.27±12.54 for CD8s, respectively). Percentage of CD25+ lymphocytes was higher in the anti-TNF plus MTX group. The Th1–17 (CCR6+CXCR3+) CD4 cell subpopulation was significantly increased in anti-TNF and anti-TNFα plus MTX groups compared with controls and MTX (10.45±3.14 vs 6.38±3.89; 10.45±3.14 vs 4.78±2.56 and 9.43±4.63 vs 6.38±3.89; 9.43±4.63 vs 4.78±2.56, respectively). Adult patients treated with anti-TNFα+MTX and MTX presented higher levels of CD21- naïve B cells compared to HC and to anti-TNF groups (4.86±3.24 vs 2.32±1.69; 4.86±3.24 vs 2.95±1.94 and 5.38±1.54 vs 2.32±1.69; 5.38±1.54 vs 2.95±1.94).ConclusionsIn depth phenotypic analysis of PBL in JIA showed alterations in cell subpopulations that seem dependent on age group. Our data also suggests that detailed in depth phenotypic analysis ...