Sa1276 Predictive Factors of Erythema Nodosum and Pyoderma Gangrenosum in a Spanish Cohort of 397 Patients With Inflammatory Bowel Disease

Abstract

AIM: To assess the factors associated with the presence of main cutaneous manifestations ((erythema nodosum-EN) and (pyoderma gangrenosum-PG)) in inflammatory bowel disease (IBD). METHODS: We included 397 patients with IBD, 68% (271/397) with Crohn's disease (CD) and 32% (126/397) with ulcerative colitis (UC), collected from 2003 to 2011. 53.7% (213/397) of them were men and 46.3% (184/397) women, with a mean age of 32.3±14.3 years and a follow-up of 9.9±6.5 years. We analyzed smoking and ethylic habit, type of IBD, activity, pattern, size of disease, family history, previous surgery, other extraintestinal manifestations, previous biological and immunosuppresive therapy, response to corticosteroids (dependent or resistant) and associated fistulae. For univariate analysis, we used the Kaplan-Meier method, whereas we used Cox's regression for multivariate analysis. RESULTS: We observed 36 cutaneous manifestations (27 EN and 9 PG), which represented a prevalence of 9.1%. In women, we found 15% (27/180) of cutaneous manifestations (21/27 EN; 6/9 PG); in men, 4.3% (9/209) (6/27 EN; 3/9 PG). According to type of IBD, CD showed 12.1% of cutaneous manifestations (24/27 EN; 8/9 PG), while UC presented 3.3% (3/27 EN; 1/9 PG). Cutaneous manifestations were found more frequently in patients with other extraintestinal manifestations than in absence of them (21% (10/47) vs 8.1% (26/321)). In univariate analysis, we found statistical significance with sex (log Rank 12.3; p=0.0001); type of IBD (log Rank 5.2; p=0.023); and the presence of other extraintestinal manifestations (log Rank 5.4; p=0.02). Previous biological therapy reached a trend (log Rank 2.5; p=0.114). In multivariate analysis, sex [H.R. 0.34 (IC 95%: 0.15-0.76); p=0.009], previous biological therapy [H.R. 0.32 (IC 95%: 0.13-0.82); p=0.018], type of IBD [H.R. 2.98 (IC 95%: 1.018.77); p=0.047] and the presence of other extraintestinal manifestations [H.R. 2.68 (IC 95%: 0.14-6.29); p=0.024] were found independently associated with EN and PG. CONCLUSION: As protective factors of appearance of erythema nodosum and pyoderma gangrenosum in inflammatory bowel disease, we found male sex, diagnosis of ulcerative colitis, previous treatment with biological therapies and the absence of other extraintestinal manifestations. Prospective studies with larger cohorts are needed to confirm these results.