Nardone Olga Maria, Calabrese Giulio, La Mantia Alessia, Villani Guido Daniele, Megna Matteo, Cacciapuoti Sara, Foglia Francesca, Peluso Rosario, D'Alessandro Ermelinda, Ferrante Mario, Testa Anna, Guarino Alessia Dalila, Rispo Antonio, Castiglione Fabiana
Gastroenterology Unit, Department of Public Health, University of Naples Federico II, via S. Pansini 5, Naples 80131, Italy.
Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Therap Adv Gastroenterol. 2025 Mar 3;18:17562848251323529. doi: 10.1177/17562848251323529. eCollection 2025.
Managing extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) patients remains challenging due to considerable heterogeneity in diagnostic criteria and the lack of a standardised definition and validated diagnostic pathways. Delays in recognising and treating EIMs can lead to significant disease progression. Therefore, early detection and treatment are crucial.
We aimed to assess the effectiveness of a dedicated immune-mediated inflammatory diseases (IMIDs) clinic in reducing EIM diagnostic delays and improving patients' outcomes.
A single-centre observational study was conducted, including IBD patients presenting with EIMs red flags.
We compared the EIMs diagnostic delay between patients who attended a multidisciplinary IMID outpatient clinic (IMID-G) and those who attended individual referral specialists representing the standard outpatient clinic group (SOC-G). We further evaluated the impact of diagnostic timing on 18-month clinical outcomes, including therapeutic changes, steroid and immunosuppressant use and biological therapy switch/swap.
We enrolled 238 IBD patients, 127 in the IMID-G and 111 in the SOC-G. The average time to EIM diagnosis was 2.48 ± 1.8 and 5.36 ± 2.3 months for the IMID and SOC-Gs (Δ = 2.88 months, = 0.005). The majority of patients received a diagnosis of peripheral arthritis (IMID-G = 37.5%; SOC-G = 33.7%) and spondyloarthropathy (IMID-G = 32.1%; SOC-G = 33.7%). No significant difference was observed in the rates of EIMs between the two groups (88.2% in IMID-G vs 92.8% in SOC-G, = 0.27). Regarding therapeutic changes, the IMID-G reported a mean time to the first therapeutic change driven by the specialist referral of 2.96 ± 1.8 months, compared to 6.09 ± 2.5 months in the SOC-G, showing a significant difference ( = 0.007). The IMID-G had a higher frequency of biological therapy switching/swapping and adding immunosuppressive treatment than the SOC-G ( = 0.008 and = 0.04, respectively). Survival curves revealed a significant reduction in diagnostic delay and time to treatment in the IMID-G compared to the SOC-G (log-rank test, < 0.001).
Attending a dedicated IMID clinic can enhance the diagnostic process for EIMs in IBD patients, thereby reducing diagnostic delays and allowing early interventions to avoid disease progression.
由于诊断标准存在相当大的异质性，且缺乏标准化定义和经过验证的诊断途径，炎症性肠病（IBD）患者的肠外表现（EIMs）管理仍然具有挑战性。EIMs识别和治疗的延迟可能导致疾病显著进展。因此，早期检测和治疗至关重要。
我们旨在评估专门的免疫介导性炎症性疾病（IMIDs）门诊在减少EIM诊断延迟和改善患者预后方面的有效性。
进行了一项单中心观察性研究，纳入出现EIMs警示信号的IBD患者。
我们比较了在多学科IMID门诊就诊的患者（IMID组）和在代表标准门诊组的个体转诊专科医生处就诊的患者（SOC组）之间的EIMs诊断延迟。我们进一步评估了诊断时机对18个月临床结局的影响，包括治疗变化、类固醇和免疫抑制剂的使用以及生物治疗的转换/更换。
我们纳入了238例IBD患者，127例在IMID组，111例在SOC组。IMID组和SOC组的EIM诊断平均时间分别为2.48±1.8个月和5.36±2.3个月（差值=2.88个月，P=0.005）。大多数患者被诊断为外周关节炎（IMID组=37.5%；SOC组=33.7%）和脊柱关节炎（IMID组=32.1%；SOC组=33.7%）。两组之间的EIMs发生率无显著差异（IMID组为88.2%，SOC组为92.8%，P=0.27）。关于治疗变化，IMID组报告因专科转诊导致的首次治疗变化的平均时间为2.96±1.8个月，而SOC组为6.09±2.5个月，显示出显著差异（P=0.007）。与SOC组相比，IMID组生物治疗转换/更换和添加免疫抑制治疗的频率更高（分别为P=0.008和P=0.04）。生存曲线显示，与SOC组相比，IMID组的诊断延迟和治疗时间显著缩短（对数秩检验，P<0.001）。
就诊于专门的IMID门诊可以加强IBD患者EIMs的诊断过程，从而减少诊断延迟并允许早期干预以避免疾病进展。
