SAT0249 IGA VASCULITIS ASSOCIATED WITH INFLAMMATORY BOWEL DISEASE. A RETROSPECTIVE STUDY

Abstract

Background: Leukocytoclastic vasculitis has been reported in patients with inflammatory bowel disease (IBD) but cases of IgA vasculitis (IgAV) in IBD are considered rare. Objectives: The purpose of this study was to describe the baseline characteristics and outcome of a series of patients with IBD and IgAV. Methods: Biopsy-proven IgAV-patients with prior history of IBD were identified retrospectively at Mayo Clinic, Rochester, MN. Data were abstracted from direct medical chart review. Each IBD-IgAV case was matched to two controls with IgAV but without IBD history based on age, sex and baseline renal function at time of IgAV onset. Results: A total of 9 patients were included in the study group (6 male, 3 female). Crohn’s disease (CD) and Ulcerative Colitis (UC) were present in 7 and 2 patients, respectively. The mean length of time between IBD diagnosis and onset of IgAV was 17.3±19.9 years. For patients on biologic treatment for IBD, the mean length of time between initiation of biologic and onset of IgAV was 3.3±3.8 years (range 0-12 years). Active IBD at IgAV-onset was present in 56% (5/9) of patients. Tumor necrosis factor inhibitors (TNFi) were the most frequent biologics used for IBD (8, 89%); infliximab was the most common (7, 78%). At IgAV-onset, only 5 patients were on treatment with TNFi; two subsequently discontinued, two switched to another TNFi (adalimumab), and one patient continued. At last follow-up, two of three patients that remained on TNFi had full resolution of IgAV despite ongoing TNFi use. Comparison of baseline characteristics between cases with IBD-IgAV and matched non-IBD IgAV controls is demonstrated in Table 1. No differences were seen in regards to development of end-stage renal disease, resolution of hematuria and/or proteinuria, time to complete IgAV response or first IgAV relapse. Conclusion: Baseline characteristics and outcomes of patients with IBD-IgAV are similar to those with IgAV without IBD. Development of IgAV is not limited to patients with clinically active IBD. Whether use of TNFi is related to the pathogenesis of IgAV in some patients with IBD remains unclear. Further research into the pathophysiologic connection between IBD and IgAV is needed.