College of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.
Department of Biostatistics, Phoenix Children's Hospital, Phoenix, Arizona, USA.
J Pediatr Gastroenterol Nutr. 2024 Nov;79(5):1009-1016. doi: 10.1002/jpn3.12370. Epub 2024 Sep 9.
The objectives of this study is to estimate rates and identify factors associated with erythema nodosum (EN) and pyoderma gangrenosum (PG) in pediatric patients with inflammatory bowel disease (IBD).
This cohort study examined longitudinal visits of patients aged ≤ 21 years from the ImproveCareNow (ICN) registry. We evaluated the association of factors at the patient-level (demographics and IBD diagnosis age) and visit-level (IBD severity scores, markers and phenotypes, comorbidities, and treatment) with the presence of EN and PG, using longitudinal logistic regression models adjusted for time and within-patient clustering.
A total of 285,913 visits from 32,497 patients aged ≤ 21 years from the ICN registry were analyzed. The occurrence of EN was 1.57% (95% confidence interval [95% CI]: 1.43%-1.71%) and the occurrence of PG was 0.90% (95% CI: 0.80%-1.00%). Co-occurrence of EN and PG was reported in 0.30% (95% CI: 0.25%-0.37%) patients. Both EN and PG were associated (p < 0.0001) with worse intestinal disease, lower remission, higher inflammatory markers, and extraintestinal manifestations (EIMs) arthritis and uveitis.
EN and PG were associated with increased disease severity and other noncutaneous EIMs (arthritis and uveitis). A small subset of patients had developed both EN and PG.
本研究旨在评估儿童炎症性肠病（IBD）患者发生结节性红斑（EN）和坏疽性脓皮病（PG）的比率，并确定相关的影响因素。
本队列研究对来自改善护理NOW（ICN）登记处的年龄≤21 岁的患者进行了纵向就诊分析。我们使用纵向逻辑回归模型，在调整时间和患者内聚类的情况下，评估了患者水平（人口统计学和 IBD 诊断年龄）和就诊水平（IBD 严重程度评分、标志物和表型、合并症和治疗）因素与 EN 和 PG 存在的相关性。
共分析了来自 ICN 登记处的 32497 名年龄≤21 岁的患者的 285913 次就诊记录。EN 的发生率为 1.57%（95%置信区间[95%CI]：1.43%-1.71%），PG 的发生率为 0.90%（95%CI：0.80%-1.00%）。报告有 0.30%（95%CI：0.25%-0.37%）的患者同时存在 EN 和 PG。EN 和 PG 均与更严重的肠道疾病、较低的缓解率、更高的炎症标志物和肠外表现（关节炎和葡萄膜炎）相关（p<0.0001）。
EN 和 PG 与疾病严重程度的增加和其他非皮肤肠外表现（关节炎和葡萄膜炎）相关。一小部分患者同时出现了 EN 和 PG。
