P628 Risk Factors Associated with Extraintestinal Manifestations in Patients with Inflammatory Bowel Diseases
Liava, C.(1);Sinakos, E.(1);Dimitroulas, T.(1);Navrozidou, C.(2);Akriviadis, E.(1);
(1)Aristotle University of Thessaloniki, Fourth Department of Internal Medicine- Hippokation General Hospital of Thessaloniki, Thessaloniki, Greece;(2)Interbalkan Medical Center of Thessaloniki, Gastroenterology Unit, Thessaloniki, Greece
Background
Risk factors associated with extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) have been evaluated mainly in retrospective studies. We aimed to determine risk factors associated with EIMs and to compare the frequency of EIMs between ulcerative colitis (UC) and Crohn’s disease (CD), based on retrospectively-prospectively collected data of a cohort of IBD patients followed in daily clinical practice.
Methods
Patients with biopsy-confirmed IBD aged 10-80 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 until March 2020. Logistic regression analysis and multivariable-adjusted models were used to examine risk factors associated with EIMs and chi-squared test was used to compare the frequency of EIMs between patients with UC and CD.
Results
300 patients with IBD (180 with CD, 113 with UC, and 7 with indeterminate colitis) were evaluated. EIMs were observed in 49% of patients, with a 2-fold increased risk in CD (OR 2.31; 95% CI:1.37-3.89; P<.005). The musculoskeletal system was affected in 38% (43% in CD vs 29% in UC, OR 1.86; 95% CI:1.08-3.20; P<.05) with peripheral arthropathy being the most common manifestation (33% in CD vs 23% in UC, P=.095), followed by dermatological manifestations (13%), with a 4-fold increased risk of erythema nodosum in CD (11% vs 3% in UC, OR 3.95; 95% CI:1.12-13.93; P<.05). On univariate logistic regression analysis history of hospitalization for IBD, history of surgery for IBD, aphthous stomatitis, perianal disease, thyroiditis Hashimoto, age, use of thiopurines, and/or anti-TNF in the past were associated with increased risk of developing EIMs. A trend for increased risk of EIMs was found for family history of IBD in first-degree relatives (OR 2.47; 95% CI:0.91-6.74; P=.078) and fecal calprotectin above 250 μg/g (OR 2.22; 95% CI:0.90-5.47; P<.084). On multivariate analysis only aphthous stomatitis (OR 4.60; 95% CI:2.32-9.13; P<.001), perianal disease (OR 2.30; 95% CI:1.17-4.50; P<.05), thyroiditis Hashimoto (OR 2.82; 95% CI:1.03-7.74; P<.05) and age (2% increase in risk per year, OR 1.02; 95% CI:1.01-1.03; P<.05) were significant for EIMs.
| % (n/N) | IBD | CD | UC | OR | 95% CI | P |
| EIMs | 48.8 | 56.5 | 36.0 | 2.31 | 1.37-3.89 | .002 |
| Musculoskeletal | 37.9 | 43.2 | 29.0 | 1.86 | 1.08-3.20 | .025 |
| Skin | 12.6 | 17.0 | 5.0 | 3.89 | 1.44-10.55 | .008 |
| Kidney | 5.5 | 6.8 | 4.0 | .349 | ||
| Liver-Biliary | 5.1 | 6.2 | 4.0 | .459 | ||
| Thromboembolic Events | 3.6 | 4.8 | 2.0 | .266 | ||
| Eye | 2.8 | 4.1 | 1.0 | .245 | ||
| Heart | 1.6 | 0.7 | 3.0 | .197 |
Conclusion
In this retrospective/prospective study 49% of IBD patients developed EIMs with a 2-fold increased risk in CD. Musculoskeletal and dermatological manifestations were the most frequent EIMs. Aphthous stomatitis, perianal disease, thyroiditis Hashimoto and age were associated with increased risk of EIMs.