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Prevalence of cerebrovascular accidents in patients with ulcerative colitis in a single academic health system. Sci Rep 2022; 12:18668. [PMID: 36333367 PMCID: PMC9636207 DOI: 10.1038/s41598-022-21253-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
In general, IBD increases arteriovenous thromboembolic events, though the association between UC and cerebrovascular complications remains inconclusive. Some studies suggest young women with UC have an increased risk of cerebrovascular accidents (CVA). The focus of this study was to characterize the rates, anatomic distribution, and risk factors for CVA in patients with UC. We developed a retrospective cohort of patients with UC at a single health care system from June 2010 to June 2015. Neuroimaging was used to document presence, location and type of stroke and traditional risk factors were considered. Prevalence of CVAs in patients with UC was compared to that of the general population of Minnesota (MN) and the United States (U.S.). A total of 2,183 UC patients were identified (1088 females [f-UC], 1095 males [m-UC]). The prevalence of CVA in UC patients (4.7%, 95% CI 3.9-5.6) was higher than in the U.S. (2.5-2.7%, p < 0.0001) and in Minnesota (1.8% CI 1.5-2.2, p < 0.0001) . The prevalence increased in both sexes with a peak prevalence of 24.7% (95% CI 17.1-34.4) in women with UC over the age of 80. Older age, cancer and atrial fibrillation were risk factors for CVA in univariate analysis for both sexes. In multifactorial analysis, both age and atrial fibrillation were risk factors for CVA in the m-UC cohort, but only age was associated with CVA in f-UC. The most common type of CVA was ischemic stroke (77.7%). The most common locations for CVAs in UC patients were frontal and occipital lobes (19% and 18%, respectively). UC patients have an increased risk for CVA, with women over 80 demonstrating the highest risk. Providers should be aware of these risks in making treatment decisions for UC.
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Windpessl M, Malzner A, Seiringer EM. Acute Colitis Heralding Pulmonary Hemorrhage. Gastroenterology 2021; 161:1384-1386. [PMID: 34280389 DOI: 10.1053/j.gastro.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Martin Windpessl
- Department of Internal Medicine IV, Section of Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria.
| | - Andrea Malzner
- Department of Internal Medicine I, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Eva M Seiringer
- Department of Internal Medicine IV, Section of Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria
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Guimarães F, Santos-Faria D, Azevedo S, Ramos Rodrigues J, Leite Silva J, Esperança-Almeida D, Ribeiro B, Vaz R, Teixeira F, Tavares-Costa J, Afonso C, Peixoto D. ANCA-associated vasculitis in a patient with enteropathic spondylarthritis: a case report and literature review. Clin Rheumatol 2021; 40:3351-3355. [PMID: 33517484 DOI: 10.1007/s10067-021-05612-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
Coexistence of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and inflammatory bowel disease (IBD) is rare (Sy et al. in Semin Arthritis Rheum 45:475-482, 2016). Nevertheless, we present a case of an AAV in a 53-year-old female with enteropathic spondylarthritis previously treated with tumor necrosis factor α inhibitors (TNFi). Management of vasculitis in a patient with IBD may be problematic due to the difficulty in distinguishing if the vasculitis is an extraintestinal manifestation of the IBD or a new coexistent entity. Moreover, in our report, the previous treatment with TNFi is a possible confounding factor due to the paradoxical effects induced by TNFi, including vasculitis (Ramos-Casals et al. in Curr Rheumatol Rep 10:442-448, 2008). The reported case alerts to the complexity in the management of patients with enteropathic spondylarthritis and vasculitis, as well as discusses the diversity of differential diagnosis in this particular clinical scenario.
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Affiliation(s)
- Francisca Guimarães
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal.
| | - Daniela Santos-Faria
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - Soraia Azevedo
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - Joana Ramos Rodrigues
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - Joana Leite Silva
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | | | | | - Raquel Vaz
- Nephrology Department, Hospital de Braga, Braga, Portugal
| | - Filipa Teixeira
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - José Tavares-Costa
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - Carmo Afonso
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - Daniela Peixoto
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
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