肠累及对早期脊柱关节炎高概率患者的影响：来自 DESIR 队列的数据。

Effect of Gut Involvement in Patients with High Probability of Early Spondyloarthritis: Data from the DESIR Cohort.

机构信息

From Rheumatology, CHRU de Besançon (University Teaching Hospital); Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE, Besançon; Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, European League Against Rheumatism (EULAR) Center Of Excellence; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France; Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium.

D. Wendling, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); X. Guillot, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Prati, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Miceli-Richard, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence; A. Molto, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; R. Lories, MD, PhD, Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven; M. Dougados, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité.

出版信息

J Rheumatol. 2020 Mar;47(3):349-353. doi: 10.3899/jrheum.181326. Epub 2019 Jun 1.

DOI:10.3899/jrheum.181326

PMID:31154418

Abstract

OBJECTIVE

Inflammatory bowel disease (IBD) is a well-known extraarticular feature of spondyloarthritis (SpA). The aims of this study were to evaluate factors associated with IBD and incidence over 5 years of followup in the DESIR cohort.

METHODS

DESIR is a prospective observational cohort of patients with recent-onset inflammatory back pain suggestive of axial SpA. All available variables in the database were compared between patients with and without IBD at baseline and 5 years, and occurrence over 5 years of followup, with uni- and then multivariable analysis.

RESULTS

At baseline, of 708 patients, 35 had IBD (prevalence 4.94%, CI 95% 3.3-6.5). IBD was associated (multivariable) with history of uveitis, levels of Dickkopf-1, and tumor necrosis factor, but not with phenotypic presentation (peripheral arthritis, enthesitis, dactylitis, uveitis) or baseline serum levels of other cytokines. At 5 years, 480 patients were analyzed, 58 with IBD. IBD was associated (multivariable) with fulfillment of modified New York criteria, sick leave, Bath Ankylosing Spondylitis Disease Activity Index, and smoking. There was no association with magnetic resonance imaging scores, enthesitis, psoriasis, and bone mineral density. Twenty-three incident cases of IBD were recorded: estimated occurrence rate of 0.95/100 (95% CI 0.57-1.35) patient-years (PY). Incidence of IBD is associated (multivariable) with HLA-B27 (OR 0.36, 95% CI 0.22-0.59), fulfillment of modified New York criteria (OR 3.35, 95% CI 1.85-6.08), and familial history of IBD (OR 3.31, 95% CI 1.62-6.77).

CONCLUSION

In early SpA, IBD occurs with an incidence of 1/100 PY, and is associated with poor outcome, familial history of IBD, absence of HLA-B27, and fulfillment of modified New York criteria.

摘要

目的

炎症性肠病（IBD）是脊柱关节炎（SpA）的一种众所周知的关节外特征。本研究旨在评估 DESIR 队列中与 IBD 相关的因素以及 5 年随访中的发病率。

方法

DESIR 是一项前瞻性观察性队列研究，纳入了近期出现炎症性背痛且提示存在轴性 SpA 的患者。在基线和 5 年时，比较数据库中所有可用变量在有无 IBD 的患者之间的差异，然后进行单变量和多变量分析。

结果

在 708 名患者中，35 名患者患有 IBD（患病率 4.94%，95%CI 3.3-6.5）。多变量分析显示，IBD 与虹膜炎病史、Dickkopf-1 水平和肿瘤坏死因子有关，但与表型（外周关节炎、附着点炎、指（趾）炎、虹膜炎）或基线时其他细胞因子的血清水平无关。在 5 年时，分析了 480 名患者，其中 58 名患者患有 IBD。多变量分析显示，IBD 与改良纽约标准、病假、巴斯强直性脊柱炎疾病活动指数和吸烟有关。与磁共振成像评分、附着点炎、银屑病和骨密度无关。记录了 23 例 IBD 新发病例：估计发病率为 0.95/100 患者年（95%CI 0.57-1.35）。IBD 的发病率（多变量分析）与 HLA-B27（OR 0.36，95%CI 0.22-0.59）、改良纽约标准的满足（OR 3.35，95%CI 1.85-6.08）和 IBD 的家族史（OR 3.31，95%CI 1.62-6.77）有关。