Association between Optic Neuritis and Inflammatory Bowel Disease: A Population-Based Study

Abstract

Extraintestinal manifestations are common in patients with inflammatory bowel disease (IBD), and optic neuritis (ON) is a rare but severe one. This study aimed to evaluate possible factors associated with ON in patients with IBD. Adult patients with IBD who were not with concomitant ON on the index date identified from the Taiwan National Health Insurance Research Database (NHIRD) from the years 2000 to 2013 were included. A four-fold matched group was selected using age, sex and year of index date for comparison. All the patients were followed up until the development of ON or the end of the study period. Data of included patients were extracted and analyzed statistically. The mean follow-up time for all patients was 7.13 ± 5.21 years. At the study period conclusion, eight (0.18%) and five (0.003%) patients with and without IBD, respectively, had developed ON (p = 0.001). Adjusted HRs showed that patients with IBD aged between 30 and 39 years, with comorbidities including neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), systemic lupus erythematosus (SLE) and with a higher Charlson Comorbidity Index, had a significantly higher risk of developing ON (all p < 0.005). Among the eight IBD patients who developed ON, only one patient was diagnosed with Crohn’s disease, the male gender was slightly dominant, and two (25%) patients received antitumor necrosis factor α (anti-TNF α) treatment for IBD. Patients with IBD have a higher risk of developing ON compared to patients without IBD. ON occurs more frequently in IBD patients aged between 30 and 39 years, with comorbidities including NMO, ADEM and SLE. Other factors besides anti-TNF α treatment for IBD are more likely associated with the development of ON.

The causal relationship between neuromyelitis optica spectrum disorder and other autoimmune diseases

“…As for the treatments, whether patients with coexisting conditions should receive the NMOSD recipe or the AD recipe or a different recipe remains unknown. One thing is for sure that tumor necrosis factor-a (TNF-a) monoclonal antibodies (mAbs) should be avoided because they increase the risk of demyelinating events (29)(30)(31)(32). Other than that, rituximab (33) (34), cyclophosphamide (35), and tocilizumab (36) have shown satisfied results.…”

Coexistence of neuromyelitis optica AQP4+, myasthenia gravis, and ulcerative colitis: a case report

“…Isolated optic neuritis can be an extraintestinal manifestation of UC and has even been described as a complication of therapy with monoclonal antibodies against tumor necrosis factor alfa (anti-TNFa) 16 . An association between UC and other demyelinating diseases of the CNS, such as multiple sclerosis or acute disseminated encephalomyelitis, has also been documented 17 . Aquaporins are ubiquitous, and their location in the colon is vital for the homeostasis of water and the pathophysiology of UC since the involvement of these channels during the inflammatory process explains the diarrhea in these patients.…”

“…The use of anti-TNFa for the treatment of IBD can unmask underlying aberrant autoimmune responses, with subsequent appearance of inflammatory events in the CNS, and its use is contraindicated in patients with an overt demyelinating disorder 17 .…”

Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It

“…Although rare, it is important to understand the pathogenesis ON and its association with IBD to prevent irreversible vision loss and impairment of quality of life. [86]. ON is often linked to other autoimmune disorders, particularly multiple sclerosis (MS), which has a higher prevalence in IBD patients compared to controls [87].…”