Đo lường trước đây nên được lấy để so sánh. Bệnh nhân cũng có thể có sự chậm trễ concomittant trong sự trưởng thành xương, được đánh giá bằng X quang xác định của bàn tay không thuận. Trì hoãn sự phát triển phổ biến hơn trong đĩa CD (60-88%) với tần số lớn nhất ở trẻ em trước tuổi dậy thì | 218 Gokhale and Kirschner a slowing of growth velocity cm yr or a fall from previous height percentile of more than one channel . 50 to 10 . Previous measurements should be obtained for comparisons. Patients may also have concomittant delay in skeletal maturation which is evaluated by radiologic determination of the nondominant hand. Delayed growth is more common in CD 60-88 with the greatest frequency in prepubertal children as compared to UC 6 -12 . Growth delay can also occur as a consequence of chronic corticosteroid use. Chronic undernutrition is considered to be a major etiologic factor in growth delay. Undernutrition results from suboptimal enteral intake as a result of anorexia and abdominal discomfort as well as increased losses because of a protein losing enteropathy. Although malabsoprption of nutrients could also occur it is rarely seen unless the patient has had extensive intestinal resection. Other contributing factors include low circulating levels of insulin-like growth factor IGF-1 or somatomedin which are seen in poorly nourished children and increase significantly following treatment 10 and elevated levels of circulating cytokines. Delayed sexual maturation or arrest of sexual maturation may occur concurrently with growth failure. Some females may also experience secondary amenorrhea caused by active disease or weight loss. Arthralgia and Arthritis Arthralgia and arthritis occur frequently in children with IBD and may occasionally precede intestinal manifestations of IBD. They usually coincide with disease activity and improve with medical treatment of underlying intestinal inflammation. Two forms of involvement are seen a peripheral form and an axial form including ankylosing spondylitis or sacroilitis. The peripheral form is usually pauciarticular affecting large joints such as knees ankles hips wrists and elbows in decreasing order of frequency. Joint deformity is rare although a destructive granulomatous synovitis has been described in CD.
