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Association between inflammatory bowel disease and spondyloarthritis: findings from a nationwide study in Sweden
Örebro University, School of Medical Sciences.
Population Health Sciences, Bristol Medical School, Bristol, United Kingdom; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital, Örebro, Sweden. (Clinical Epidemiology and Biostatistics)
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-8391-1576
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2022 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 16, no 1, p. 1540-1550Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) has been associated with spondyloarthritis (SpA), but population-based estimates are scarce. Here we compare the occurrence of SpA before and after a diagnosis of IBD to the general population, overall and by IBD subtype and age.

METHODS: We used a nationwide register-based cohort study of 39,203 patients diagnosed with IBD during 2006-2016, identified from Swedish registers and gastrointestinal biopsy data, and 390,490 matched reference individuals from the general population. Conditional logistic regression models were used to estimate odds ratios (ORs) for a prior (prevalent) SpA diagnosis and conditional Cox regression to calculate hazard ratios (HRs) for a subsequent (incident) SpA diagnosis in IBD patients.

RESULTS: IBD patients were more likely to have prevalent SpA at IBD diagnosis (2.5%) compared to reference individuals (0.7%) with an OR of 3.48 (95%CI:3.23-3.75). They also more often received an incident diagnosis of SpA; during 23,341,934 person-years of follow-up in IBD patients, there were 1,030 SpA events (5.0/1,000 person-years) compared to 1,524 SpA events in the reference group (0.72/1,000 person-years), corresponding to an HR of 7.15 (95%CI:6.60-7.75). In subgroup analyses, associations were most pronounced among patients with Crohn's disease [(OR=5.20; 95%CI:4.59-5.89), and (HR=10.55; 95%CI:9.16-12.15)] and paediatric onset IBD [(OR=3.63; 95%CI:2.35-5.59) and (HR=15.03; 95%CI:11.01-20.53)].

CONCLUSION: IBD patients more frequently experience SpA both before and after the diagnosis of IBD compared to the general population, supporting evidence of a shared pathophysiology. The variation in SpA comorbidity across IBD subtypes and age-groups, calls for targeted approaches to facilitate timely diagnosis and intervention.

Place, publisher, year, edition, pages
Oxford University Press, 2022. Vol. 16, no 1, p. 1540-1550
Keywords [en]
epidemiology, inflammatory bowel diseases, population-based study, spondyloarthritis
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-98862DOI: 10.1093/ecco-jcc/jjac065ISI: 000813274200001PubMedID: 35512691Scopus ID: 2-s2.0-85141889167OAI: oai:DiVA.org:oru-98862DiVA, id: diva2:1656438
Funder
European Commission, 754285Swedish Research Council, 2020-02021
Note

Funding agency:

Orebro University Hospital Research Foundation OLL-936004 OLL-890291 OLL-790011 OLL-723021

Available from: 2022-05-06 Created: 2022-05-06 Last updated: 2025-02-11Bibliographically approved
In thesis
1. Impact of age and inflammation on extraintestinal manifestations of inflammatory bowel disease
Open this publication in new window or tab >>Impact of age and inflammation on extraintestinal manifestations of inflammatory bowel disease
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, is often complicated by extraintestinal manifestations (EIMs) that affect organs beyond the gastrointestinal tract. The EIMs can significantly impair quality of life and complicate disease management in patients with IBD. As the population ages, understanding the interplay between age, chronic inflammation, and EIMs becomes increasingly important for optimizing patient care and outcomes. Thus, the overall aim of the thesis was to assess the impact of age and inflammation on EIM of IBD.

We conducted all studies using Swedish national registers. To evaluate the accuracy of the National patient register (NPR), we compared International classification of diseases (ICD) coded IBD data with clinical records from 1403 IBD patients. For investigating spondyloarthritis (SpA) comorbidity, a cohort of 39,203 IBD patients diagnosed between 2006-2016 and 390,490 matched reference individuals were analyzed. The familial risk of SpA was assessed among 147,080 first-degree relatives (FDRs) and 25,945 spouses of IBD patients. The influence of colectomy on SpA and other EIMs was studied in 3246 ulcerative colitis patients, comparing EIM rates before and after surgery.

The NPR showed high positive predictive values (PPVs) for Crohn's disease (97%) and ulcerative colitis (98%) but a low PPV for IBD-unclassified (8%). Crohn's disease location and behaviour had variable PPVs, indicating frequent misclassification. A high PPV (95%) was observed for age at diagnosis of IBD. Patients with IBD had significantly higher relative risk estimates of SpA both before (odds ratio [OR]: 3.48) and after (hazard ratio [HR]: 7.15) IBD diagnosis compared to the general population. FDRs of IBD patients exhibited a higher risk of SpA (HR: 1.35). Spouses also had an elevated SpA risk, suggesting environmental influences. The highest risks were observed in Crohn's disease and pediatric-onset IBD. Post-colectomy, patients with ulcerative colitis experienced increased EIM rates (rate ratios [RR]: 1.83). In addition, de novo EIMs frequently occurred in patients with no history of EIMs before colectomy.

The NPR is a reliable source for subtype of IBD, although improvements are needed for phenotypic accuracy. IBD significantly increases the risk of SpA. The elevated SpA risk among FDRs and spouses points to shared genetic and environmental factors. Colectomyin patients with ulcerative colitis does not mitigate the risk of EIMs, indicating a need for continued monitoring and management post-surgery. This thesis underscores the importance of comprehensive care approaches that address both gastrointestinal and extraintestinal challenges in IBD.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2024. p. 99
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 295
Keywords
inflammatory bowel disease, Crohn's disease, ulcerative colitis, ageing, spondyloarthritis, extraintestinal manifestations, colectomy, epidemiology
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-113987 (URN)9789175295671 (ISBN)9789175295688 (ISBN)
Public defence
2024-09-20, Örebro universitet, Campus USÖ, Tidefeltsalen, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2024-05-30 Created: 2024-05-30 Last updated: 2024-08-27Bibliographically approved

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Shrestha, SaritaSchoultz, IdaMontgomery, ScottLudvigsson, Jonas F.Halfvarson, Jonas

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