Maillet François, Nguyen Yann, Espitia Olivier, Perard Laurent, Salvarani Carlo, Rivière Etienne, Ndiaye Dieynaba, Durel Cécile-Audrey, Guilpain Philippe, Mouthon Luc, Kernder Anna, Loricera Javier, Cohen Pascal, Melki Isabelle, de Moreuil Claire, Limal Nicolas, Mékinian Arsène, Costedoat-Chalumeau Nathalie, Morel Nathalie, Boutemy Jonathan, Raffray Loïc, Allain Jean-Sébastien, Devauchelle Valérie, Kone-Paut Isabelle, Fabre Marc, Durel Marie, Dossier Antoine, Abad Sébastien, Visentini Marcella, Bigot Adrien, Yildiz Halil, Fain Olivier, Samson Maxime, Gondran Guillaume, Abitbol Vered, Terrier Benjamin
Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Disease, Cochin University Hospital, AP-HP, Paris, France.
Department of Internal Medicine, Beaujon University Hospital, AP-HP.Nord, Université Paris Cité, Clichy, France.
Rheumatology (Oxford). 2025 Jun 1;64(6):3724-3732. doi: 10.1093/rheumatology/keaf030.
To describe the characteristics and outcome of patients with the association of large vessel vasculitis (LVV, Takayasu arteritis [TA] or GCA) and IBD.
An observational, multicentre, retrospective case-control study. Cases were LVV-IBD patients from European countries, whereas controls had isolated LVV (iLVV).
A total of 39 TA-IBD and 12 GCA-IBD cases were enrolled, compared with 52 isolated GCA (iGCA) and 93 isolated TA (iTA) controls. LVV occurred after IBD in 56% in TA-IBD and 75% in GCA-IBD, with a median interval of 1 year (interquartile range [IQR] 1-7) in TA-IBD and 8.6 years (IQR 1-17.7) in GCA-IBD. Crohn's disease was more common in TA-IBD (67%), whereas ulcerative colitis was more common in GCA-IBD (58%). Compared with iTA, TA-IBD were significantly younger at diagnosis of TA (median age 27 vs 37 years, P < 0.001) and had more upper limb claudication (36% vs 12%, P = 0.006). GCA-IBD patients had more frequent arterial thickening or stenosis than controls (75% vs 30%, respectively, P = 0.044) and tended to more frequently involve gastrointestinal arteries (20% vs 0%, respectively, P = 0.06). LVV occurred in IBD patients despite treatment with glucocorticoids (36%), azathioprine (25%) or TNF-alpha blockers (29%). The presence of the IBD was not associated with a higher LVV relapse rate in multivariate analysis (adjusted hazard ratio [aHR] 0.62 [0.13-2.83] for GCA and aHR 0.92 [0.44-1.89] for TA).
This study identifies specific clinical and imaging characteristics of LVV-IBD patients, in particular a more severe vascular presentation of GCA-IBD patients compared with iGCA patients.
描述合并大血管血管炎（LVV，即高安动脉炎[TA]或巨细胞动脉炎[GCA]）与炎症性肠病（IBD）患者的特征及预后。
一项观察性、多中心、回顾性病例对照研究。病例为来自欧洲国家的LVV-IBD患者，而对照为孤立性LVV（iLVV）患者。
共纳入39例TA-IBD和12例GCA-IBD病例，与之相比，有52例孤立性GCA（iGCA）和93例孤立性TA（iTA）对照。在TA-IBD中，56%的患者LVV发生于IBD之后，在GCA-IBD中这一比例为75%；TA-IBD中两者出现的中位间隔时间为1年（四分位间距[IQR]1 - 7），GCA-IBD中为8.6年（IQR 1 - 17.7）。克罗恩病在TA-IBD中更常见（67%），而溃疡性结肠炎在GCA-IBD中更常见（58%）。与iTA相比，TA-IBD患者诊断TA时明显更年轻（中位年龄27岁对37岁，P < 0.001），且上肢跛行更常见（36%对12%，P = 0.006）。GCA-IBD患者动脉增厚或狭窄比对照组更频繁（分别为75%对30%，P = 0.044），且倾向于更频繁累及胃肠道动脉（分别为20%对0%，P = 0.06）。尽管使用了糖皮质激素（36%）、硫唑嘌呤（25%）或肿瘤坏死因子-α阻滞剂（29%）治疗，LVV仍在IBD患者中发生。在多变量分析中，IBD的存在与更高的LVV复发率无关（GCA的校正风险比[aHR]为0.62[0.13 - 2.83]，TA的aHR为0.92[0.44 - 1.89]）。
本研究确定了LVV-IBD患者的特定临床和影像学特征，特别是与iGCA患者相比，GCA-IBD患者的血管表现更严重。
