<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2182-5173</journal-id>
<journal-title><![CDATA[Revista Portuguesa de Medicina Geral e Familiar]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Port Med Geral Fam]]></abbrev-journal-title>
<issn>2182-5173</issn>
<publisher>
<publisher-name><![CDATA[Associação Portuguesa de Medicina Geral e Familiar]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2182-51732024000500498</article-id>
<article-id pub-id-type="doi">10.32385/rpmgf.v40i5.13970</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Uma adolescente com espondilartrite e doença de Crohn]]></article-title>
<article-title xml:lang="en"><![CDATA[Spondyloarthritis and Crohn&#8217;s disease in an adolescent]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Marto]]></surname>
<given-names><![CDATA[Liliana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Baptista]]></surname>
<given-names><![CDATA[Tiago]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sousa,]]></surname>
<given-names><![CDATA[Renata Arantes]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martins]]></surname>
<given-names><![CDATA[Carla R.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Araújo]]></surname>
<given-names><![CDATA[Sara Faria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cruz]]></surname>
<given-names><![CDATA[Ana Lúcia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pinhão]]></surname>
<given-names><![CDATA[Ana Raquel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Morais]]></surname>
<given-names><![CDATA[Catarina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,ULS do Alto Minho USF Tiago de Almeida ]]></institution>
<addr-line><![CDATA[Viana do Castelo ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,ULS do Alto Minho USF Tiago de Almeida ]]></institution>
<addr-line><![CDATA[Viana do Castelo ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>10</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>10</month>
<year>2024</year>
</pub-date>
<volume>40</volume>
<numero>5</numero>
<fpage>498</fpage>
<lpage>504</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2182-51732024000500498&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2182-51732024000500498&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2182-51732024000500498&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  Este caso clínico descreve a jornada de uma adolescente que manifesta um quadro marcado por sintomas articulares e intestinais, permitindo evidenciar a relação entre espondilartrite e doença de Crohn.  Descrição do caso:  Adolescente de 15 anos recorre à consulta com a sua médica de família por dor articular, nomeadamente gonalgia bilateral e lombossacralgia, tendo a marcha diagnóstica indiciado uma possível doença autoimune, suportada por marcadores inflamatórios alterados e critérios de sacro-ileíte em ressonância magnética nuclear. Posteriormente surgiu um quadro de diarreia e hemorragia retal, tendo a colonoscopia revelado pancolite e ulcerações. Principais diagnósticos, terapêutica e resultados: a avaliação inicial por reumatologia sugeriu os diagnósticos diferenciais de espondilartrite e artrite idiopática juvenil. Neste contexto foram introduzidos analgésicos anti-inflamatórios não esteroides e prednisolona. Solicitou-se a colaboração de gastrenterologia pediátrica que, após articulação conjunta com reumatologia e a medicina geral e familiar, enquadrou os sintomas gastrointestinais num diagnóstico provável de espondilartrite associada a doença de Crohn, optando-se pela terapêutica com adalimumab.  Comentário:  Este caso destaca a importância da colaboração interdisciplinar na gestão de diagnósticos complexos e estabelecimento de estratégias terapêuticas adequadas em patologias autoimunes concomitantes. No âmbito da medicina geral e familiar, este caso reforça o papel do médico de família como gestor do doente e como elemento fulcral na aceitação da doença crónica pelo utente e sua família.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  This case report follows an adolescent female with articular and bowel symptoms, highlighting the association between spondyloarthritis and Crohn&#8217;s disease.  Case description:  The first symptoms were joint pain, mainly in the knee and lower back leading to a possible autoimmune disease diagnosis, supported by elevation of inflammatory markers and magnetic resonance imaging showing sacroilitis. After that, the patient developed diarrhea and rectal bleeding, with colonoscopy revealing pancolitis and ulcerations. Main diagnosis, therapeutics, and results: The initial evaluation by a rheumatology specialist suggested spondyloarthritis or juvenile idiopathic arthritis as differential diagnosis establishing treatment with non-steroidal anti-inflammatory drugs and prednisolone. Cooperation with gastroenterology led to the diagnosis of spondyloarthritis associated with Crohn&#8217;s disease, changing the medication to adalimumab.  Comment:  This clinical case report highlights the importance of interdisciplinary cooperation when managing complex diagnoses and establishing suitable therapeutical strategies in autoimmune diseases. This case reinforces the role of the family doctor as a patient manager and as a key element in the acceptance of chronic illness by the patient and their family.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Espondilartrite]]></kwd>
<kwd lng="pt"><![CDATA[Doença de Crohn]]></kwd>
<kwd lng="pt"><![CDATA[Adalimumab]]></kwd>
<kwd lng="en"><![CDATA[Spondyloarthritis]]></kwd>
<kwd lng="en"><![CDATA[Crohn&#8217;s disease]]></kwd>
<kwd lng="en"><![CDATA[Adalimumab]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Karreman]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Luime]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Hazes]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Weel]]></surname>
<given-names><![CDATA[AE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The prevalence and incidence of axial and peripheral spondyloarthritis in inflammatory bowel disease a systematic review and meta-analysis]]></article-title>
<source><![CDATA[J Crohns Colitis]]></source>
<year>2017</year>
<volume>11</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>631-42</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ranasinghe]]></surname>
<given-names><![CDATA[IR]]></given-names>
</name>
<name>
<surname><![CDATA[Tian]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Hsu]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<source><![CDATA[Crohn disease]]></source>
<year>2023</year>
<publisher-loc><![CDATA[Treasure Island ]]></publisher-loc>
<publisher-name><![CDATA[StatPearls Publishing]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ossum]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Palm]]></surname>
<given-names><![CDATA[Ø]]></given-names>
</name>
<name>
<surname><![CDATA[Lunder]]></surname>
<given-names><![CDATA[AK]]></given-names>
</name>
<name>
<surname><![CDATA[Cvancarova]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Banitalebi]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Negård]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Ankylosing spondylitis and axial spondyloarthritis in patients with long-term inflammatory bowel disease results from 20 years of follow-up in the IBSEN study]]></article-title>
<source><![CDATA[J Crohns Colitis]]></source>
<year>2018</year>
<volume>12</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>96-104</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lim]]></surname>
<given-names><![CDATA[CS]]></given-names>
</name>
<name>
<surname><![CDATA[Tremelling]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Hamilton]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Kim]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Macgregor]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Turmezei]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevalence of undiagnosed axial spondyloarthritis in inflammatory bowel disease patients with chronic back pain secondary care cross-sectional study]]></article-title>
<source><![CDATA[Rheumatology (Oxford)]]></source>
<year>2023</year>
<volume>62</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>1511-8</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Danve]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Deodhar]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Axial spondyloarthritis in the USA diagnostic challenges and missed opportunities]]></article-title>
<source><![CDATA[Clin Rheumatol]]></source>
<year>2019</year>
<volume>38</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>625-34</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Peyrin-Biroulet]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Loftus Jr]]></surname>
<given-names><![CDATA[EV]]></given-names>
</name>
<name>
<surname><![CDATA[Colombel]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
<name>
<surname><![CDATA[Sandborn]]></surname>
<given-names><![CDATA[WJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Long-term complications, extraintestinal manifestations, and mortality in adult Crohn's disease in population-based cohorts]]></article-title>
<source><![CDATA[Inflamm Bowel Dis]]></source>
<year>2011</year>
<volume>17</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>471-8</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tromm]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[May]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Almus]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Voigt]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Greving]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Schwegler]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cutaneous manifestations in inflammatory bowel disease]]></article-title>
<source><![CDATA[Z Gastroenterol]]></source>
<year>2001</year>
<volume>39</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>137-44</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Abdesslem]]></surname>
<given-names><![CDATA[NB]]></given-names>
</name>
<name>
<surname><![CDATA[Mahjoub]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Sayadi]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Zbiba]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Ocular manifestations of Crohn's disease]]></article-title>
<source><![CDATA[Tunis Med]]></source>
<year>2019</year>
<volume>97</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>692-7</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Youssef]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Novosad]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Winthrop]]></surname>
<given-names><![CDATA[KL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Infection risk and safety of corticosteroid use]]></article-title>
<source><![CDATA[Rheum Dis Clin North Am]]></source>
<year>2016</year>
<volume>42</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>157-76</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mokhtare]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Valizadeh]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Emadian]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Lower gastrointestinal bleeding due to non-steroid anti-inflammatory drug-induced colopathy case report and literature review]]></article-title>
<source><![CDATA[Middle East J Dig Dis]]></source>
<year>2013</year>
<volume>5</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>107-11</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
