Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.
Dig Dis Sci. 2024 Sep;69(9):3375-3381. doi: 10.1007/s10620-024-08575-7. Epub 2024 Jul 29.
The development of certain immune-mediated diseases (IMD) in patients with inflammatory bowel diseases [IBD; Crohn's disease (CD), ulcerative colitis (UC)] has been linked to treatment of IBD. Hair loss in some patients may be due to immune-mediated alopecia areata (AA). Risk factors and outcomes of AA in patients with IBD have not been previously explored.
This was a retrospective, multi-center case-control study. Cases were identified as individuals who developed IBD before AA diagnosis. Controls comprised of those who were never diagnosed with AA and treated contemporaneously, selected using random number generator. We extracted demographic and IBD treatment history. Severity of Alopecia Tool (SALT) was used to stratify AA severity. AA outcomes and interventions were compared within controls.
We identified 58 cases and 90 controls. Cases had significantly higher rate of tumor necrosis factor α antagonist (anti-TNF) use compared to controls (40.7% vs. 20.0%, p = 0.006). Both groups had similar IBD disease location, behavior, and related surgery. Majority of cases had endoscopic remission or mild disease activity at AA diagnosis. There was no difference in partial or complete improvement of AA between those who stopped or continued IBD therapy (p = 0.57). Those with severe AA were significantly less likely to have complete (0% vs 33.3%, p = 0.01) or any improvement (50% vs 84.9%, p = 0.02) of AA compared to those with non-severe AA.
Individuals with IBD who later develop AA were more likely to have been on anti-TNF at time of AA onset. Severity of AA was a significant predictor of AA resolution. Fortunately many patients had improvement in their AA despite continuation of IBD therapy.
某些免疫介导性疾病（IMD）在炎症性肠病[IBD；克罗恩病（CD），溃疡性结肠炎（UC）]患者中的发展与 IBD 的治疗有关。一些患者的脱发可能是由于免疫介导性斑秃（AA）引起的。IBD 患者 AA 的风险因素和结局以前尚未探讨过。
这是一项回顾性、多中心病例对照研究。病例被确定为在 AA 诊断前患有 IBD 的个体。对照组由从未被诊断为 AA 且同时接受治疗的个体组成，使用随机数生成器选择。我们提取了人口统计学和 IBD 治疗史。使用脱发严重程度工具（SALT）对 AA 严重程度进行分层。在对照组中比较了 AA 的结局和干预措施。
我们确定了 58 例病例和 90 例对照。与对照组相比，病例使用肿瘤坏死因子-α拮抗剂（抗-TNF）的比例明显更高（40.7% vs. 20.0%，p=0.006）。两组的 IBD 疾病部位、行为和相关手术均相似。大多数病例在 AA 诊断时处于内镜缓解或轻度疾病活动状态。停止或继续 IBD 治疗对 AA 的部分或完全改善没有差异（p=0.57）。与非严重 AA 相比，严重 AA 的患者完全（0% vs. 33.3%，p=0.01）或任何改善（50% vs. 84.9%，p=0.02）的可能性明显降低。
以后发展为 AA 的 IBD 个体在 AA 发病时更有可能使用抗-TNF。AA 的严重程度是 AA 缓解的重要预测因素。幸运的是，许多患者尽管继续接受 IBD 治疗，但其 AA 仍有所改善。
