Shani Uria, Ben-Shabat Niv, Qassem Roula, Lahat Adi, Omar Mahmud, Savin Einat, Dotan Arad, Patt Yonatan Shneor, Fisher Lior, Zacay Galia, Amital Howard, Watad Abdulla, Sharif Kassem
Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.
Therap Adv Gastroenterol. 2024 Jan 27;17:17562848241227037. doi: 10.1177/17562848241227037. eCollection 2024.
The skin-gut axis, characterized by bidirectional communication between the skin and gut, plays a crucial role in the pathogenesis of psoriasis and inflammatory bowel diseases (IBD).
We aimed to explore the association between psoriasis and IBD and identify predictors associated with IBD development among patients with psoriasis.
Retrospective cohort study.
A retrospective study which utilized an electronic database from the Meuhedet Health Maintenance Organization (MHMO) in Israel. Psoriasis was categorized as severe if any systemic agent or phototherapy was administered. Univariate and multivariate logistic regressions were used to identify specific predictors for IBD, with adjustments made for potential confounders. The study received approval from the Ethical Committee of the MHMO.
In total, 61,003 adult patients who were diagnosed with psoriasis between 2000 and 2022 were included. Among them, 1495/61,003 patients (2.4%) were diagnosed with IBD, as compared to 3834/244,012 patients (1.6%) in the non-psoriasis group [adjusted odds ratio (OR): 1.47; 95% confidence interval (CI): 1.37-1.56; < 0.001]. Increased age (OR: 1.01; 95% CI: 1.01-1.02; < 0.001), male gender (OR: 1.22; 95% CI: 1.03-1.45; = 0.024), and Jewish ethnicity (OR: 2.5; 95% CI: 1.2-4.1; < 0.001) were identified as significant risk factors for IBD. Spondyloarthropathies, including psoriatic arthritis (OR: 2.27; 95% CI: 1.86-2.77; < 0.001) and ankylosing spondylitis (OR: 2.82; 95% CI: 1.5-5.32; < 0.05), were associated with a higher prevalence of IBD. Furthermore, severe psoriasis was significantly associated with a higher likelihood of IBD, compared to mild psoriasis (OR: 16.03; 95% CI: 11.02-23.34; < 0.001).
A significant association between psoriasis and IBD was demonstrated, including its subtypes: Crohn's disease and ulcerative colitis. Moreover, such association may depend on psoriasis severity as determined by the treatment used. This association warrants further investigation and implies a potential need for closer monitoring of patients with severe psoriasis.
以皮肤与肠道之间双向交流为特征的皮肤-肠道轴在银屑病和炎症性肠病（IBD）的发病机制中起关键作用。
我们旨在探讨银屑病与IBD之间的关联，并确定银屑病患者中与IBD发生相关的预测因素。
回顾性队列研究。
一项回顾性研究，利用了以色列梅乌赫德特健康维护组织（MHMO）的电子数据库。如果使用了任何全身用药或光疗，则将银屑病分类为重度。使用单变量和多变量逻辑回归来确定IBD的特定预测因素，并对潜在混杂因素进行调整。该研究获得了MHMO伦理委员会的批准。
总共纳入了2000年至2022年间被诊断为银屑病的61003例成年患者。其中，1495/61003例患者（2.4%）被诊断为IBD，而非银屑病组中为3834/244012例患者（1.6%）[调整后的优势比（OR）：1.47；95%置信区间（CI）：1.37-1.56；P<0.001]。年龄增加（OR：1.01；95%CI：1.01-1.02；P<0.001）、男性（OR：1.22；95%CI：1.03-1.45；P=0.024）和犹太族裔（OR：2.5；95%CI：1.2-4.1；P<0.001）被确定为IBD的显著危险因素。脊柱关节病，包括银屑病关节炎（OR：2.27；95%CI：1.86-2.77；P<0.001）和强直性脊柱炎（OR：2.82；95%CI：1.5-5.32；P<0.05），与IBD的较高患病率相关。此外，与轻度银屑病相比，重度银屑病与IBD的可能性显著相关（OR：16.03；95%CI：11.02-23.34；P<0.001）。
银屑病与IBD之间存在显著关联，包括其亚型：克罗恩病和溃疡性结肠炎。此外，这种关联可能取决于所使用治疗方法确定的银屑病严重程度。这种关联值得进一步研究，并意味着可能需要对重度银屑病患者进行更密切的监测。
