ABSTRACT 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.
Ülkersoy et al. (Thu,) studied this question.