Patients with inflammatory bowel disease have increased risk of autoimmune and inflammatory diseases

Abstract

AIMTo investigate whether immune mediated diseases (IMD) are more frequent in patients with inflammatory bowel disease (IBD).METHODSIn this population based registry study, a total of 47325 patients with IBD were alive and registered in the Danish National Patient Registry on December 16, 2013. Controls were randomly selected from the Danish Civil Registration System (CRS) and matched for sex, age, and municipality. We used ICD 10 codes to identify the diagnoses of the included patients. The IBD population was divided into three subgroups: Ulcerative colitis (UC), Crohn’s disease (CD) and Both the latter referring to those registered with both diagnoses. Subsequently, odds-ratios (OR) and 95%CI were obtained separately for each group and their respective controls. The use of Bonferoni post-test correction adjusted the significance level to P < 0.00125. P-values were estimated using Fisher’s exact test.RESULTSThere were significantly more women than men in the registry, and a greater percentage of comorbidity in the IBD groups (P < 0.05). Twenty different IMDs were all significantly more frequent in the IBD group. Sixteen were associated with UC versus twelve with CD. In both UC and CD ORs were significantly increased (P < 0.00125) for primary sclerosing cholangitis (PSC), celiac disease, type 1 diabetes (T1D), sarcoidosis, asthma, iridocyclitis, psoriasis, pyoderma gangrenosum, rheumatoid arthritis, and ankylosing spondylitis. Restricted to UC (P < 0.00125) were autoimmune hepatitis, primary biliary cholangitis, Grave’s disease, polymyalgia rheumatica, temporal arteritis , and atrophic gastritis. Restricted to CD (P < 0.00125) were psoriatic arthritis and episcleritis. Restricted to women with UC (P < 0.00125) were atrophic gastritis, rheumatoid arthritis, temporal arteritis, and polymyalgia rheumatica. Restricted to women with CD were episcleritis, rheumatoid arthritis, and psoriatic arthritis. The only disease restricted to men (P < 0.00125) was sarcoidosis.CONCLUSIONImmune mediated diseases were significantly more frequent in patients with IBD. Our results strengthen the hypothesis that some IMDs and IBD may have overlapping pathogenic pathways.

Systematic review with meta‐analysis: risk of new onset IBD with the use of anti‐interleukin‐17 agents

“…A number of case reports and clinical studies have reported new onset IBD with the initiation of anti‐IL‐17 agents . It is well known that patients with immune‐mediated diseases are at increased risk of developing or having a history of IBD . Therefore, comparing patients who received anti‐IL‐17 agents and those receiving placebo therapies in RCTs can help determine whether the risk of new onset IBD is attributed to anti‐IL‐17 agents or it is simply the natural evolution of IBD in susceptible patients.…”

“…PlaceboAnti-IL-17 drug Brodalumab; P = 1.00, Heterogeneity; I 2 = 0 %, Q = 0, P = 1.00 lxekizumab; P = 0.20, Heterogeneity; I 2 = 0 %, Q = 0.15, P = 1.00 Secukinumab; P = 0.70, Heterogeneity; I 2 = 0 %, Q = 1.33, P = 1.00 Overall; P = 0.35, heterogeneity; I 2 = 0 %, Q = 2.41, P = 1.00 of developing IBD in patients treated with anti-IL-17 agents compared to placebo.A number of case reports and clinical studies have reported new onset IBD with the initiation of anti-IL-17 agents 15,16. It is well known that patients with immune-mediated diseases are at increased risk of developing or having a history of IBD [42][43][44]. Therefore, comparing patients who received anti-IL-17 agents and those receiving placebo therapies in RCTs can help determine whether the risk of new onset IBD is attributed to anti-IL-17 agents or it is simply the natural evolution of IBD in susceptible patients.…”

Is celiac disease really associated with inflammatory bowel disease?

“…However, the prevalence of CeD in cohorts of patients with IBD remains unclear. In the study performed on a registry including 47,325 Danish patients with IBD immune system-related disorders, including CeD, were found to be more common, likely because of overlapping between signaling and cell activation pathways (21). An Italian study supports this theory, but their cohort of patients with UC is very small (n = 27) (22).…”

Towards Individualized Use of Probiotics and Prebiotics for Metabolic Syndrome and Associated Diseases Treatment: Does Pathophysiology-Based Approach Work and Can Anticipated Evidence Be Completed?

“…Gut microbiota is involved in regulating both Th1 and Th2 immune response. Thus, in patients with IBD the gut microbiota has been shown to be of less diversity, an altered microbial metabolite profile with reduced number of bacteria compared to healthy individuals has been demonstrated [79]. A similar etiology is believed to exist in rheumatoid arthritis, ankylosing spondylitis, multiple sclerosis, type 1 diabetes mellitus (T1DM), and celiac disease [80].…”