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Two common factors, cigarette smoking and appendectomy, have been found to play a role in ulcerative colitis (UC). Data on their role in the development of extraintestinal manifestations (EIM) are scarce.
The relationship between cigarette smoking, appendectomy, and EIM was examined in a prospective study involving 535 (M/F = 319/216) consecutive U...
Contexts in source publication
Context 1
... 112 patients were considered lost to follow-up. The characteristics of patients with and without EIMs are summarized in Table 1. The extension of disease is the maximum mucosa involvement endoscopically observed during the follow-up period. ...
Context 2
... relation of patients' diagnosis of EIMs with smoking habits, appendectomy, and age at onset of UC was analyzed with use of Cox proportional-hazard model. Even though the female sex appeared associated with EIMs in the univari- ate analysis (Table 1), it was not included in the multivariate model because it appeared strongly related to appendectomy (Table 3), and for this reason it was not considered as an in- dependent variable. The Cox analysis showed that smoking and appendectomy are independent predictors of EIMs, with patients appendectomized representing the category with the highest risk for EIMs (Table 4, top). ...
Citations
... Joint involvement in IBD is categorized into two subgroups: axial and peripheral [4]. Active bowel illness, a family history of IBD, appendectomy, tobacco use and the presence of various extraintestinal symptoms, including erythema nodosum or pyoderma gangrenosum, are all possible risk factors associated with arthritis in IBD patients [5][6][7][8]. ...
... patients, whereas left colon involvement occurred in four (57.1%) patients. The median length of EA was 4 years (range: 3-7), whereas the median duration of IBD was 8.5 years (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Prior to tofacitinib treatment, two (28.6%) ...
Objective: The aim of this study was to evaluate the efficacy of ustekinumab in the treatment of enteropathic arthritis. Materials & methods: A systematic literature search was performed in the Pubmed database of publications between January 2010 and October 2021. Demographic characteristics, comorbidities, inflammatory bowel disease and enteropathic arthritis symptoms, other extraintestinal findings, medical treatments and clinical and laboratory findings for all cases were recorded. Results: A total of 11 patients were included. While clinical and laboratory remission was achieved in terms of inflammatory bowel disease in all patients and enteropathic arthritis in nine patients after ustekinumab treatment, other extraintestinal findings for all patients completely regressed after treatment. Conclusion: Ustekinumab may be an appropriate treatment option for this patient group, considering both pathogenesis and successful treatment responses.
... Joint involvement in IBD is categorized into two subgroups: axial and peripheral [4]. Active bowel illness, a family history of IBD, appendectomy, tobacco use and the presence of various extraintestinal symptoms, including erythema nodosum or pyoderma gangrenosum, are all possible risk factors associated with arthritis in IBD patients [5][6][7][8]. ...
... patients, whereas left colon involvement occurred in four (57.1%) patients. The median length of EA was 4 years (range: 3-7), whereas the median duration of IBD was 8.5 years (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Prior to tofacitinib treatment, two (28.6%) ...
Background/aim: The JAK-STAT pathway is involved in the pathogenesis of both the inflammatory bowel disease (IBD) and spondyloarthropathy group of diseases. The purpose of this study was to evaluate the effectiveness of tofacitinib, a Janus kinase inhibitor, in the treatment of enteropathic arthritis (EA). Materials & methods: The study included seven patients, four from the authors' follow-up and three from the literature. All cases were recorded for demographic characteristics, comorbidities, IBD and EA symptoms, medical treatments and changes in clinical and laboratory results with treatment. Results & conclusion: Clinical and laboratory remission in terms of IBD and EA was achieved in three patients after tofacitinib treatment. For both spondyloarthritis spectrum diseases and IBD, tofacitinib may be an appropriate choice, as its efficacy has been shown in both conditions.
... A number of studies suggest that smoking is not a risk factor for the development of cutaneous EIM (when including both PG and EN) in IBD patients [3,28,46]. However, in one prospective cohort study of ulcerative colitis patients, there was a significant relationship between (current) smoking and the development of PG [47]. In our IBD cohort, a history of tobacco use (former or current cigarette smokers) was not correlated with an increase in PG incidence. ...
Background
Pyoderma gangrenosum (PG) is an uncommon but severe extra-intestinal manifestation (EIM) of inflammatory bowel disease (IBD). The incidence and risk factors for PG are disputed.
Aims
To assess the incidence of PG and identify factors associated with PG in IBD patients.
Methods
A search of electronic databases (Ovid and PubMed) was conducted between 1966 and 2019. Studies that calculated the incidence of PG in IBD patient cohorts were included. Patient demographics, IBD subtype, and EIM presence were recorded. A review of our institutional database of 1057 IBD patients was conducted. A multivariate regression model and meta-analysis were conducted to identify risk factors for PG. A random effects model was used to combine the data of included studies.
Results
Fourteen studies were included in addition to 1057 IBD patients and 26 PG cases from the Louisville cohort. In total, there were 379 cases of PG in the cumulative cohort of 61,695 IBD patients. The PG incidence in individual studies ranged from 0.4 to 2.6%. In the institutional cohort, ocular EIMs and a permanent stoma were significant risk factors for PG. In the meta-analysis, PG was associated with female gender (RR = 1.328, 95% CI 1.161–1.520), Crohn’s disease (RR = 1.193, 95% CI 1.001–1.422), erythema nodosum (RR = 9.281, 95% CI 6.081–14.164), and ocular EIM (RR = 4.55, 95% CI 3.04–6.81). There was study heterogeneity when assessing IBD subtype, ocular, and joint EIMs.
Conclusions
There are conflicting data on the incidence and risk factors for PG. This meta-analysis confirms an association between PG and female gender, Crohn’s disease, erythema nodosum, and ocular EIM that have been described in smaller studies.
... Smoking status was classified as either current smoker or never/past smoker. The adjustment for smoking was performed owing to the conflicting evidence regarding its impact on predisposing inflammatory bowel disease-associated PG [14][15][16][17]. ...
The coexistence of pyoderma gangrenosum (PG) and gout has been reported in individual patients; however, the association between these conditions has not been investigated. We aimed to assess the association between PG and gout and to examine whether the presence of gout predisposes to the development of PG. A population-based case-control study was conducted comparing PG patients (n = 302) with age-, sex-, and ethnicity-matched control subjects (n = 1497) with respect to the presence of preceding gout. Logistic regression models were utilized for univariate and multivariate analyses. The prevalence of preceding gout was greater in patients with PG than in control subjects (3.7% vs. 0.7%, respectively; p < 0.001). Gout was associated with a more than fivefold increase in the risk of PG (OR, 5.15; 95% CI, 2.21–11.98). After adjusting for confounding factors, gout emerged as a significant independent predictor of PG (adjusted OR, 4.08; 95% CI, 1.69–9.80). Gout preceded the diagnosis of PG by a median latency of 4.6 years. Patients with gout-associated PG were older, predominantly male, and had a higher prevalence of metabolic syndrome than other patients with PG. In conclusion, gout increases the risk of developing PG by more than fivefold. Physicians managing patients with gout and PG should be aware of this emerging association.
... Furthermore, Yüksel et al [28] , examining the characteristics of peripheral arthritis in patients with IBD, they found that erythema nodosum and pyoderma gangrenosum were more commonly observed in IBD patients who also had peripheral arthritis, compared to those without. Various risk factors have been reported for peripheral arthritis in the context of IBD including: family history of IBD, appendicectomy, smoking and presence of other extra-intestinal manifestations [19,40,41] . ...
Spondyloarthropathies (SpA) include many different forms of inflammatory arthritis and can affect the spine (axial SpA) and/or peripheral joints (peripheral SpA) with Ankylosing spondylitis (AS) being the prototype of the former. Extra-articular manifestations, like uveitis, psoriasis and inflammatory bowel disease (IBD) are frequently observed in the setting of SpA and are, in fact, part of the SpA classification criteria. Bowel involvement seems to be the most common of these manifestations. Clinically evident IBD is observed in 6%-14% of AS patients, which is significantly more frequent compared to the general population. Besides, it seems that silent microscopic gut inflammation, is evident in around 60% in AS patients. Interestingly, occurrence of IBD has been associated with AS disease activity. For peripheral SpA, two different forms have been proposed with diverse characteristics. Of note, SpA (axial or peripheral) is more commonly observed in Crohn's disease than in ulcerative colitis. The common pathogenetic mechanisms that explain the link between IBD and SpA are still ill-defined. The role of dysregulated microbiome along with migration of T lymphocytes and other cells from gut to the joint ("gut-joint" axis) has been recognized, in the context of a genetic background including associations with alleles inside or outside the human leukocyte antigen system. Various therapeutic modalities are available with monoclonal antibodies against tumour necrosis factor, interleukin-23 and interleukin-17, being the most effective. Both gastroenterologists and rheumatologists should be alert to identify the co-existence of these conditions and ideally follow-up these patients in combined clinics.
... Musculoskeletal manifestations can precede the diagnosis of IBD; they could appear simultaneously with or after the diagnosis [9]. Risk factors for developing SpA in IBD patients are active bowel disease, a family history of IBD, a history of appendectomy, smoking, or extra-intestinal manifestations such as erythema nodosum and pyoderma gangrenosum [10,11]. A large study following 470 patients with IBD for 20 years found a high prevalence of inflammatory axial disorders occurring late in the course of the disease. ...
Rheumatic musculoskeletal manifestations are increasingly recognized as a major cause of morbidity and impaired quality of life in patients with inflammatory bowel diseases (IBDs). IBDs are associated with a variety of musculoskeletal pathologies, from peripheral arthritis to axial involvement, and from localized or regional pathologies to diffuse metabolic disorders. Recent advances, especially in imaging techniques, allow a better understanding of these pathologies, and assist their recognition even in the preclinical phase. This review aims to describe the musculoskeletal clinical and imaging manifestations in IBD with special emphasis on the current concepts and the updated radiological work-up.
... [139][140][141] On the simplest level, demographic and clinical factors may be used to detect risk. For example, female sex, 29,63,113,[142][143][144][145][146] CD rather than UC, 113,142,143,147,148 increasing age, 29,143,149 long disease duration, 142,143 colonic location in CD, 100,143 extensive UC compared with proctitis, 142,147 indicators of severe disease including the need for steroids, 146 azathioprine, 146 biologic therapy, 29 or surgery, 100,144,148 and smoking both in CD 29,148 and UC 29,150 have all been associated with an increased risk for EIMs. However, these associations are not reported consistently and are not replicated in all population-based studies [147][148][149] and, as such, this approach may have limited applicability in clinical practice. ...
This article reports on the sixth scientific workshop of the European Crohn’s and Colitis Organisation [ECCO] on the pathogenesis of extraintestinal manifestations [EIMs] in inflammatory bowel disease [IBD]. This paper has been drafted by 15 ECCO members and 6 external experts [in rheumatology, dermatology, ophthalmology, and immunology] from 10 European countries and the USA. Within the workshop, contributors formed subgroups to address specific areas. Following a comprehensive literature search, the supporting text was finalized under the leadership of the heads of the working groups before being integrated by the group consensus leaders.
... Consequently, female PsA patients had a significantly increased risk to developed CD, as also reported by other authors [18]. Finally, bowel involvement was more common in established form and in axial subset, in PsA patients with higher disease activity, and in nonsmoker patients, supporting the idea that the risk of IBD and extra-intestinal manifestation is markedly increased in smokers [19]. The relationship between PsA and ocular inflammation has been well recognized [20,21]. ...
Background: Whereas the relationship between subclinical atherosclerosis and antiphospholipid syndrome (APS) has been widely investigated, little is known about subclinical atherosclerosis in asymptomatic carriers with isolated antiphospholipid antibodies positivity (APP). Methods: Consecutive APP carriers, APS subjects and matched controls were enrolled. Intima-media thickness of the common carotid artery (CCA-IMT) and of the Bulb (Bulb-IMT) and the prevalence of carotid plaques were assessed in all enrolled subjects. Results: A total of 104 APP carriers, 221 APS subjects, and 325 matched controls were recruited. As compared with controls, APP carriers and APS subjects showed a higher CCA-IMT (0.90 ± 0.24 vs 0.82 ± 0.12, p = 0.014 and 0.93 ± 0.42 vs 0.82 ± 0.12, p < 0.001, respectively), Bulb-IMT (1.10 ± 0.44 vs 0.95 ± 0.18, p = 0.006 and 1.22 ± 0.68 vs 0.95 ± 0.18, p < 0.001, respectively) and an increased prevalence of carotid plaques (33.7% vs 10.2%, p < 0.001 and 38.5% vs 10.2%, p < 0.001, respectively). These results were confirmed stratifying for antibody isotype, after excluding subjects with systemic lupus erythematosus or other autoimmune diseases and after adjusting for major clinical and demographic variables. CCA-IMT, Bulb-IMT and the prevalence of carotid plaques were higher in subjects with high-titer antibodies and progressively increased for an increasing number of positive antibodies. Conclusions: Similar to APS subjects, APP carriers have enhanced subclinical atherosclerosis, a more severe disease being observed in the presence of high-titer antibodies and multiple antibodies positivity. These data argue for a strict monitoring of subclinical signs of atherosclerosis and of cardiovascular risk factors in asymptomatic APP carriers.
... [139][140][141] On the simplest level, demographic and clinical factors may be used to detect risk. For example, female sex, 29,63,113,[142][143][144][145][146] CD rather than UC, 113,142,143,147,148 increasing age, 29, 143, 149 long disease duration, 142,143 colonic location in CD, 100,143 extensive UC compared to proctitis, 142, 147 indicators of severe disease including need for steroids, 146 azathioprine, 146 biological therapy 29 or surgery, 100,144,148 and smoking both in CD 29,148 and UC 29,150 have all been associated with an increased risk for EIM. However, these associations are not reported consistently and are not replicated in all populationbased studies [147][148][149] and as such, this approach may have limited applicability in clinical practice. ...
Background
Approximately 50% of inflammatory bowel disease (IBD) patients experience at least one extraintestinal manifestation (EIM) during their disease course. The pathogenic mechanisms that cause EIM are incompletely understood, however unravelling these pathways has the potential to enhance our understanding of the pathogenesis of IBD overall and improve patient care.
Methods
The workshop comprised gastroenterologists of ECCO as well as experts from rheumatology, ophthalmology and dermatology. One group critically appraised the scientific evidence supporting a range of proposed pathogenic mechanisms of EIM, whilst the second group defined strategies and clinical tools that could be employed in future research in EIM. Unanswered questions in the field of EIM were identified.
Results
In order to facilitate systematic inclusion of patients in scientific and clinical studies and to align outcome measures across studies, research evaluating EIM needs to be underpinned by widely agreed definitions of the pathology being studied. However, such clear criteria are often lacking in EIM. We considered the evidence supporting the role of the gut microbiota and genotype in EIM pathogenesis as well as the differential therapeutic efficacy of drugs in IBD and EIMs, which may reveal pathogenic mechanisms. We defined two broad groups of speculative immune pathways: 1. Extension of immune responses from the intestine and 2. EIM as independent, but associated inflammatory events. The adequacy of the currently available animal models for the investigation of pathogenic mechanisms in EIM was appraised. The biomarkers and clinical and patient-reported outcome measures currently available to assess inflammation in different somatic systems were compared and suggestions made for future clinical and research use.
Conclusions
There is an urgent need to increase understanding of pathogenesis of EIM both to identify new molecular treatment targets, as well as to enhance the strategic application of the currently available drugs according to the character and somatic distribution of inflammation in individual patients. New knowledge challenges traditional organ-based paradigms and we predict that consideration of the total inflammatory burden will drive treatment decisions and define clinical and research outcomes in the future. Many currently available clinical and patient-reported outcome measures are organ-based; therefore novel tools for diagnosis and monitoring of inflammation are needed.
... Beslek et al. found in their study which included 122 patients (28 CD and 94 UC) that a higher frequency of women was observed in patients diagnosed as spondyloarthritis [36]. Correlation between smoking and rheumatic manifestations of IBD had been discussed with contradictory results [30,[37][38][39]. In this study, there was no association between smoking and the presence of AS. ...
Aim of the work
To determine the frequency, clinical and radiological features of axial spondyloarthritis in patients with inflammatory bowel diseases (IBD) and to characterize differences between patients with and without axial spondyloarthritis.
Patients and Methods
Patients included in this cross-sectional study were recruited from the Gastroenterology Department, University of Tunisia over six months. Sixty-four patients with IBD were questioned and examined for axial spondyloarthritis symptoms. Standard pelvic X-rays were performed for all and CT scans and MRI were done for some patients.
Results
There were 42 men (65.6%) and 22 women (34.4%) with a mean age of 47 ± 22 years. 32 patients (50%) had Crohn’s disease, 31 had ulcerative colitis and 1 patient has undifferentiated colitis. The disease was confined to the colon among a half of patients with ulcerative colitis. Regarding Crohn’s disease, all lesions were confined to the ileum and the colon. The mean IBD duration was 6.18±7.2 years. The occurrence of axial spondyloarthritis was 26.5% (17 patients who were symptomatic in 16 cases). The bowel disease preceded rheumatic manifestations in all cases. Nine patients (14.1%) had isolated sacroiliitis. The patients with and without axial spondyloarthritis had similar sociodemographic, anthropometric characteristics, comorbidities and bowel disease particularities except a higher percentage of corticosteroids use (p = .013).
Conclusions
Due to the high frequency, an early diagnosis of spondyloarthritis in patients with inflammatory bowel disease by thorough clinical exam and standard pelvic X-rays should be recommended.
