Abstract
Introduction: Dermatological conditions such as erythema nodosum (EN), pyoderma gangrenosum (PG), Sweet’s syndrome and aphthous stomatitis can occur with inflammatory bowel disease (IBD) and are considered dermatological extraintestinal manifestations (D-EIMs). Rarely they may precede IBD. Other common conditions such as psoriasis have also been associated with IBD. This study examined the risk of a subsequent IBD diagnosis in subjects presenting with a D-EIM.
Methods: A retrospective cohort study compared subjects with D-EIMs and age/sex-matched subjects without D-EIMs. Hazard ratios (HR) were adjusted for age, sex, body mass index, deprivation, comorbidity, smoking, loperamide use, anaemia and lower gastrointestinal symptoms. Logistic regression was used to produce a prediction model for the diagnosis of IBD within 3-years of EN diagnosis.
Results: 7,447 subjects with D-EIMs (74% female, median age 38 (IQR 24-65) years) were matched to 29,297 subjects without D-EIMs. 131 (1.8%) subsequent IBD diagnoses were observed in those with D-EIMS compared to 65 (0.2%) in those without. Median time to IBD diagnosis was 205 (IQR 44-661) days in those with D-EIMs and 1,594 (693-2,841) in those without. The adjusted HR for later diagnosis of IBD was 6.16 (95%CI 4.53-8.37),p<0.001; for ulcerative colitis 3.30 (1.98-5.53),p<0.001 and for Crohn’s disease 8.54 (5.74-12.70),p<0.001. Subjects with psoriasis had a 34% increased risk of a subsequent IBD diagnosis compared to matched controls (1.34 (1.20-1.51), p<0.001).4,043 subjects with an incident EN diagnosis were included in the prediction model cohort with 87 (2.2%) diagnosed with IBD within 3-years. The model had a bias-corrected c-statistic of 0.82 (95% CI 0.78-0.86).
Conclusions: Subjects with D-EIMs have a six-fold increased risk of later diagnosis of IBD. Younger age, smoking, low BMI, anaemia and lower gastrointestinal symptoms were associated with increased risk of diagnosis of IBD within 3-years in subjects with EN
Methods: A retrospective cohort study compared subjects with D-EIMs and age/sex-matched subjects without D-EIMs. Hazard ratios (HR) were adjusted for age, sex, body mass index, deprivation, comorbidity, smoking, loperamide use, anaemia and lower gastrointestinal symptoms. Logistic regression was used to produce a prediction model for the diagnosis of IBD within 3-years of EN diagnosis.
Results: 7,447 subjects with D-EIMs (74% female, median age 38 (IQR 24-65) years) were matched to 29,297 subjects without D-EIMs. 131 (1.8%) subsequent IBD diagnoses were observed in those with D-EIMS compared to 65 (0.2%) in those without. Median time to IBD diagnosis was 205 (IQR 44-661) days in those with D-EIMs and 1,594 (693-2,841) in those without. The adjusted HR for later diagnosis of IBD was 6.16 (95%CI 4.53-8.37),p<0.001; for ulcerative colitis 3.30 (1.98-5.53),p<0.001 and for Crohn’s disease 8.54 (5.74-12.70),p<0.001. Subjects with psoriasis had a 34% increased risk of a subsequent IBD diagnosis compared to matched controls (1.34 (1.20-1.51), p<0.001).4,043 subjects with an incident EN diagnosis were included in the prediction model cohort with 87 (2.2%) diagnosed with IBD within 3-years. The model had a bias-corrected c-statistic of 0.82 (95% CI 0.78-0.86).
Conclusions: Subjects with D-EIMs have a six-fold increased risk of later diagnosis of IBD. Younger age, smoking, low BMI, anaemia and lower gastrointestinal symptoms were associated with increased risk of diagnosis of IBD within 3-years in subjects with EN
| Original language | English |
|---|---|
| Pages (from-to) | 1731-1739 |
| Journal | Inflammatory Bowel Diseases |
| Volume | 27 |
| Issue number | 11 |
| Early online date | 9 Jan 2021 |
| DOIs | |
| Publication status | E-pub ahead of print - 9 Jan 2021 |
Keywords
- Crohn’s disease
- Sweet’s syndrome
- aphthous stomatitis
- dermatological
- erythema nodosum
- extra intestinal manifestations
- inflammatory bowel disease
- psoriasis
- pyoderma gangrenosum
- ulcerative colitis