Department of Medicine, Division of Gastroenterology and Hepatology and Division of Rheumatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Rheumatol. 2012 Nov;39(11):2148-52. doi: 10.3899/jrheum.120321. Epub 2012 Sep 15.
Spondyloarthritis (SpA) is an extraintestinal manifestation of inflammatory bowel disease with significant clinical effects, although the frequency is uncertain. We assessed the cumulative incidence and clinical spectrum of SpA in patients with Crohn's disease (CD) in a population-based cohort.
The medical records of a population-based cohort of Olmsted County, Minnesota, residents diagnosed with CD between 1970 and 2004 were reviewed. Patients were followed longitudinally until migration, death, or December 31, 2010. We used the European Spondylarthropathy Study Group, Assessment of Spondyloarthritis international Society (ASAS) criteria and modified New York criteria to identify patients with SpA. The Kaplan-Meier method was used to estimate the cumulative incidence of SpA following diagnosis of CD.
The cohort included 311 patients with CD (49.8% females; median age 29.9 yrs, range 8-89). Thirty-two patients developed SpA based on ASAS criteria. The cumulative incidence of SpA after CD diagnosis was 6.7% (95% CI 2.5%-6.7%) at 10 years, 13.9% (95% CI 8.7%-18.8%) at 20 years, and 18.6% (95% CI 11.0%-25.5%) at 30 years. The 10-year cumulative incidence of ankylosing spondylitis was 0, while both the 20-year and 30-year cumulative incidences were 0.5% (95% CI 0-1.6%).
We have for the first time defined the actual cumulative incidence of SpA in CD using complete medical record information in a population-based cohort. The cumulative incidence of all forms of SpA increased to approximately 19% by 30 years from diagnosis of CD. Our results emphasize the importance of maintaining a high level of suspicion for SpA when following patients with CD.
脊柱关节炎（SpA）是炎症性肠病的一种肠道外表现，具有显著的临床影响，尽管其发生频率尚不确定。我们评估了人群队列中克罗恩病（CD）患者的 SpA 累积发病率和临床谱。
我们对明尼苏达州奥姆斯特德县的一个基于人群的队列中诊断为 CD 的患者的病历进行了回顾。患者进行了纵向随访，直到迁移、死亡或 2010 年 12 月 31 日。我们使用欧洲脊柱关节炎研究组、脊柱关节炎评估国际协会（ASAS）标准和改良纽约标准来识别 SpA 患者。Kaplan-Meier 方法用于估计 CD 诊断后 SpA 的累积发病率。
该队列包括 311 名 CD 患者（49.8%为女性；中位年龄 29.9 岁，范围 8-89 岁）。32 名患者根据 ASAS 标准诊断为 SpA。CD 诊断后 SpA 的累积发病率在 10 年时为 6.7%（95%CI 2.5%-6.7%），在 20 年时为 13.9%（95%CI 8.7%-18.8%），在 30 年时为 18.6%（95%CI 11.0%-25.5%）。10 年时强直性脊柱炎的累积发病率为 0，而 20 年和 30 年的累积发病率均为 0.5%（95%CI 0-1.6%）。
我们首次使用人群队列中的完整病历信息定义了 CD 患者 SpA 的实际累积发病率。所有形式的 SpA 的累积发病率在 CD 诊断后 30 年增加到约 19%。我们的研究结果强调了在随访 CD 患者时保持高度怀疑 SpA 的重要性。
