Abstract
AimAnkylosing spondylitis (AS) primarily affects the axial skeleton and extraarticular structures. Small-scaled studies have reported that the incidence and prevalence of inflammatory bowel disease (IBD) are higher in patients with AS than in the general population. This study determined the incidence of IBD in patients with AS using a large scale population-based cohort dataset.MethodsThis was a retrospective cohort study. Patient data were collected from the Taiwan National Health Insurance Research Database from 2000 to 2012. We enrolled 3,804 patients with AS and 7,608 non-AS patients. The endpoint was IBD diagnosis by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding 555 and 556 after at least three outpatient visits or one hospital admission, until the end of 2012. The Kaplan–Meier analysis was performed to discriminate the cumulative incidence of IBD and the log-rank test was used to test the significance. A Cox proportional hazard model was used to estimate the hazard ratio (HR) for IBD between the AS and non-AS groups.ResultsAmong the population as a whole the Cox proportional hazard regression indicated that patients aged ≥65 years [adjusted HR (aHR): 2.48, 95% confidence interval (CI): 1.38–4.47] or with comorbidity of cancer (aHR: 3.51, 95% CI: 1.40–8.80) had a higher HR for IBD. Kaplan–Meier curves of cumulative incidence proportion of IBD indicated that patients with AS had a higher risk of IBD than the non-AS group in the subgroup aged <40 years (HR: 2.85, 95% CI: 1.51–5.40, p = 0.001).ConclusionsPatients with AS aged <40 years had a higher IBD risk than did those without AS in Taiwan. Clinicians and patients should be aware of this association.
Highlights
Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD), ulcerative colitis (UC), and indeterminate colitis (IBD-unclassified), is a group of chronic relapsing inflammatory disorder affecting the gastrointestinal (GI) tract caused by a complex interaction of genetic factors, environmental exposures, and immune response dysregulation
Among the population as a whole the Cox proportional hazard regression indicated that patients aged ≥65 years [adjusted hazard ratio (HR): 2.48, 95% confidence interval (CI): 1.38–4.47] or with comorbidity of cancer had a higher HR for IBD
Kaplan–Meier curves of cumulative incidence proportion of IBD indicated that patients with Ankylosing spondylitis (AS) had a higher risk of IBD than the non-AS group in the subgroup aged
Summary
Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD), ulcerative colitis (UC), and indeterminate colitis (IBD-unclassified), is a group of chronic relapsing inflammatory disorder affecting the gastrointestinal (GI) tract caused by a complex interaction of genetic factors, environmental exposures, and immune response dysregulation. CD can trigger inflammation in any part of the GI tract and results in various GI and systemic symptoms, such as abdominal pain, diarrhea, fistulae, weight loss, and anorexia. UC is characterized by inflammation in the colon, which leads to abdominal pain and subsequent diarrhea. Studies have reported an association between IBD and arthritis [1, 2]. IBD incidence and prevalence are higher in patients with psoriasis, psoriatic arthritis, and AS than in the general population.[3] The estimated overall incidence of IBD in patients with AS is 5%– 10%, with approximately 60% of patients with AS presenting subclinical ileal inflammation [4]. We examined the IBD risk in Taiwanese patients with AS using the large Taiwan National Health Insurance Research Database (NHIRD) and compared the risk in patients with AS with that in matched comparison cohort patients without AS
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