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Background: Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD), Ulcerative colitis (UC), and undetermined colitis may be related to psoriasis and psoriatic arthritis (PsA). Biologic therapy (BT) is useful in PsA and IBD but paradoxically has been related to IBD.
Objectives: In a wide series of PsA, our aim was to assess a ) the epidemiological and clinical features of associated IBD and b ) its relationship with BT.
Methods: All unselected consecutive patients studied in a single reference University Hospital with : a ) PsA (CASPAR criteria) and b ) IBD: CD, UC and undetermined colitis diagnosed by endoscopic patterns, clinical criteria and laboratory tests. A comparative study between patients with and without IBD was performed
Results: We studied 306 (165 women/141 men) patients with PsA; mean age at PsA diagnosis of 41.7±15.79 years; delay of diagnosis from the onset of symptoms of 2.6±2.01 years. IBD (CD=6; UC=1 and undetermined colitis=3) was observed in 10 of 306 (3.3%, 8 women/2 men). A significant more frequency of enthesitis, positive HLA-B27 and non-significant more severe PsA (axial, and hip involvement, and a higher BASDAI, BASFI, DAPSA, PASI) was observed in patients with associated-IBD ( TABLE).
IBD was present before PsA in 5 patients and in the other 5, after 9.6±15.3 years of evolution of PsA. BT for PsA has been used in 1 (20%) (etanercept) of these 5 patients which developed IBD and in 67 of 296 (22.6%) without IBD (Adalimumab 45; Certolizumab 8; Infliximab 6; Golimumab 4; Etanercept 4).
Conclusion: IBD in PsA was uncommon (3.3%), may be associated to a more severe PsA, and no relationship to BT was found.
|
Patients with IBD
|
Patients without IBD
| p | |
|---|---|---|---|
| DEMOGRAPHIC PARAMETERS | |||
| Sex, n (%) | 2 ♂/8 ♀ (20.0/80.0) | 139 ♂/157 ♀ (46.9/53.1) | p = 0.11 |
| Age at PsA symptoms onset (years), mean± SD | 39.0±15.1 | 44.2±11.4 | p = 0.17 |
| Age at PsA diagnosis, mean±SD | 41.7±15.7 | 46.4±15.8 | p = 0.22 |
| PsA RELATED DATA | |||
| PsA type | |||
| Asymmetric Oligoarticular, n (%) | 4.0 (40.0) | 159 (53.7) | p = 0.59 |
|
| 0.0 (0.0) | 46 (15.5) | p = 0.37 |
| Axial, n (%) | 3.0 (30.0) | 40 (13.5) | p = 0.31 |
| Mixed, n (%) | 3.0 (30.0) | 51 (17.2) | p = 0.54 |
| Enthesitis, n (%) | 7.0 (70.0) | 111 (37.5) | p = 0.03* |
| Dactylitis, n (%) | 0.0 (0.0) | 79 (26.7) | p = 0.70 |
| Hip involvement n (%) | 4.0 (40.0) | 55 (18.5) | p = 0.57 |
| Scores | |||
| BASDAI, median [ICR] | 3.1 [0.0-4.4] | 2.2 [0.0-4.5) | p = 0.64 |
| BASFI, median [ICR] | 6.0[0.0–6.9] | 0.0 [0.0-3.3] | p = 0.69 |
| DAPSA, median [ICR] | 10.7 [0.0–14.62] | 4.3 [0.0-13.0] | p = 0.31 |
| PASI, median [ICR] | 2.3 [0.0–6.7] | 0.6 [0.0-2.38] | p = 0.70 |
| Laboratory tests: HLA-B27, n (%) | 6.0 (60.0) | 23 (7.8) | p = 0.001* |
Disclosure of Interests: Lara Sanchez-Bilbao Grant/research support from: Pfizer, David Martinez-Lopez: None declared, Natalia Palmou-Fontana: None declared, Susana Armesto: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD