Are extraintestinal manifestations associated with disease outcomes in inflammatory bowel diseases? Results from the Veszprem population based inception cohort database

Abstract

Background and Aims: Association between extraintestinal manifestations (EIM) and disease activity suggest a common pathogenic link. Limited data are available on the effect of EIMs on the long-term disease course in inflammatory bowel diseases (IBD). The aim of this study was to analyze the association between the presence of EIMs (joint, skin, eyes) and treatment steps and long term disease outcomes in the population-based inception cohort in the Veszprem province database after 1977. Methods: A well-characterized Hungarian cohort of 506 incident cases with Crohn's disease (male/female: 251/255, age at diagnosis: 31.5 years, SD 13.8 years) diagnosed from January 1, 1977 were included and data of 347 incident UC patients diagnosed from January 1, 2002 were analyzed (m/f: 200/147, median age at diagnosis: 36, IQR: 26 – 50 years, duration: 7, IQR 4 – 10 years). Follow-up data were collected until December 31, 2012. Both in- and outpatient records were collected and comprehensively reviewed. Results: EIMs (Joint, skin and eyes) were present in 32.2% of the CD and 17.3% of the UC patients. Presence of EIMs was associated in both CD and UC with female gender (pCD = 0.01, pUC = 0.07), with ileocolonic and extensive location (pCD = 0.009, pUC = 0.003). In CD, there was an association with smoking (p < 0.001), but not in UC. No association was found in both CD and UC between the presence of EIMs and need for surgery/colectomy. Presence of EIMs was associated with the need for azathioprine (pCD< 0.001; pUC = 0.004) and need for steroids (pCD < 0.001, pUC < 0.001) in both diseases, but anti-TNF therapy was only associated in CD (p < 0.001). In Kaplan-Meier analysis there was an association between the presence of EIMs and time to first UC-related hospitalization (p = 0.002). Conclusions: In IBD, the presence of EIM was associated higher maximum treatment steps during the disease course including need for steroids, azathioprine. In CD, there was an association with anti-TNF therapy while in UC with the need for hospitalization.