NEWS: IBD Patients Prone to Other Autoimmune or Inflammatory Disorders - CME Teaching Brief - MedPage Today

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IBD Patients Prone to Other Autoimmune or Inflammatory Disorders

By Neil Osterweil, Senior Associate Editor, MedPage Today

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University

of Pennsylvania School of Medicine.

September 01, 2005



MedPage Today Action Points

Monitor patients with IBD who are receiving TNFα blockers such as

Enbrel, Humira, or Remicade for signs of possible co-morbid

conditions such as demyelinating or autoimmune disorders.

Inform patients with IBD that these studies were both retrospective

and not randomized, and are therefore subject to interpretation or

selection bias.

Review

PHILADELPHIA, Sept. 1-As if inflammatory bowel disease isn't enough,

it seems that patients with IBD may be prone to demyelinating

diseases such as multiple sclerosis, and to other inflammatory

conditions such as arthritis and asthma.

Researchers at the University of Pennsylvania here looked at records

of nearly 8,000 patients with Crohn's disease, and more than 12,000

with ulcerative colitis, and found that the rate of MS, optic

neuritis, or demyelination was about 2.5 times greater among patients

with IBD compared with controls.

In a second study, investigators at the University of Manitoba in

Winnipeg used information from a province-wide IBD database to

determine that patients with IBD were significantly more likely than

matched controls to suffer from other inflammatory disease such as

asthma, arthritis, bronchitis, psoriasis, and pericarditis.

In the Canadian study, patients with ulcerative colitis (but not

Crohn's disease) were also significantly more likely to have chronic

renal disease and MS.

The studies " underline the propensity of our patients with IBD for

developing autoimmune disorders affecting multiple organ systems, "

wrote V. Loftus, Jr., M.D., of the Mayo Clinic College of

Medicine in Rochester, Minn., in an editorial accompanying the

studies. All three articles are published in the September issue of

Gastroenterology.

The Philadelphia group, led by D. , M.D., of the Penn

Presbyterian Medical Center, conducted a retrospective cohort study

and a retrospective cross-sectional study of data on 7,988 patients

with Crohn's disease and 12,185 with ulcerative colitis who were

treated between 1988 and 1997.

They were prompted to look for a possible link on the basis of

historical studies showing an approximate threefold risk for MS in

IBD patients, and on more recent reports of MS or similar conditions

in patients being treated with drugs that inhibit tumor necrosis

factor-α (TNFα). These agents include the monoclonal antibodies

Remicade (infliximab), Humira (adalimumab), and the fusion protein

Enbrel (etanercept).

They matched the cases to 80,666 randomly selected controls from

primary care practices.

The investigators found that in the cohort study the incidences of

MS, demyelination, and optic neuritis were significantly higher among

patients with IBD. The incidence rate ratio -- the likelihood of

being diagnosed with one of the demyelination disorders after an IBD

diagnosis compared with controls -- was 2.63 (95% confidence

interval, 1.29-5.15), for patients with ulcerative colitis, and 2.12

(95% CI, .94-4.50) for patients with Crohn's. The IRR for optic

neuritis did not reach statistical significance.

In the cross-sectional study, the odds ratio that a patient with

Crohn's disease would have MS or one of the other conditions was 1.54

(95% CI, 1.03-2.32). For patients with ulcerative colitis the OR was

1.75 (95% CI, 1.28-2.39).

" Demyelinating diseases occur more frequently among patients with IBD

than among non-IBD patients, " the authors wrote. They added that

further studies may determine whether treatment with TNFα blockers

contribute to the incidence of MS and related disorders in these

patients.

The Canadian study, by N. Bernstein, M.D., and colleagues at

the University of Manitoba in Winnipeg, used longitudinal data from

1984 to 2003 from a population-based database in the province. They

selected 10 controls for every one patient with IBD, matched for age,

sex, and geographic locations.

They found a total of 8,072 cases of IBD in the study period,

comprising 3,879 patients with ulcerative colitis, and 4,193 with

Crohn's, and looked for the rate of co-morbidities in this group and

in the controls. They determined a co-morbidity to be any condition

(based on ICD-9 coding) requiring five or more health-system contacts.

They found that patients with colitis were significantly more likely

than controls to have asthma, bronchitis, arthritis, MS, chronic

renal disease, psoriasis and pericarditis. Patients with Crohn's

disease had elevated prevalence of all of these conditions as well,

with the exception of chronic renal disease and MS.

" The finding of asthma as the most common co-morbidity increased in

Crohn's disease is novel, " Dr. Bernstein and colleagues wrote. " These

may be diseases with common causes or complications of one disease

that lead to the presentation with another. Studies such as this

should encourage further research into the common triggers in the

organ systems that lead to autoimmune diseases. "

As pointed out by Dr. Loftus in his accompanying editorial, " many

immune-mediated conditions are thought, like IBD, to be polygenic,

and it is likely that some of these conditions share susceptibility

genes, both in the major histocompatibility region of chromosome 6

and in non-major histocompatibility areas. "

http://www.medpagetoday.com/Gastroenterology/InflammatoryBowelDisease/

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