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Zhang X, Zhou L, Qian X. The Mechanism of "Treating Different Diseases with the Same Treatment" by Qiangji Jianpi Decoction in Ankylosing Spondylitis Combined with Inflammatory Bowel Disease: A Comprehensive Analysis of Multiple Methods. Gastroenterol Res Pract 2024; 2024:9709260. [PMID: 38808131 PMCID: PMC11132832 DOI: 10.1155/2024/9709260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/30/2024] Open
Abstract
Background Ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) are prevalent autoimmune disorders that often co-occur, posing significant treatment challenges. This investigation adopts a multidisciplinary strategy, integrating bioinformatics, network pharmacology, molecular docking, and Mendelian randomization, to elucidate the relationship between AS and IBD and to investigate the potential mechanisms of traditional Chinese medicine formulations, represented by Qiangji Jianpi (QJJP) decoction, in treating these comorbid conditions. Methods We utilized databases to pinpoint common targets among AS, IBD, and QJJP decoction's active compounds through intersection analysis. Through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses, we mapped a network in Cytoscape, isolating critical targets. Molecular docking with AutoDock validated the affinity between targets and compounds. ROC analysis and dataset validation assessed diagnostic performance, while Gene Set Enrichment Analysis (GSEA) offered pathway insights. Mendelian randomization explored the AS-IBD causal relationship. Results Screening identified 105 targets for QJJP decoction, 414 for AS, and 2420 for IBD, with 85 overlapping. These targets predominantly participate in organismal responses and DNA transcription factor binding, with a significant cellular presence in the endoplasmic reticulum and vesicle lumen. Molecular docking, facilitated by Cytoscape, confirmed IL1A, IFNG, TGFB1, and EDN1 as critical targets, with IFNG demonstrating diagnostic potential through GEO dataset validation. The integration of GSEA with network pharmacology highlighted the therapeutic significance of the relaxin, osteoclast differentiation, HIF-1, and AGE-RAGE signaling pathways in QJJP decoction's action. Mendelian randomization analysis indicated a positive causal relationship between IBD and AS, pinpointing rs2193041 as a key SNP influencing IFNG. Conclusion Based on the principle of "treating different diseases with the same method" in traditional Chinese medicine theory, we explored the intricate mechanisms through which QJJP decoction addresses AS and IBD comorbidity. Our research spotlighted the pivotal role of the IFNG gene. IFNG emerges not only as a key therapeutic target but also assumes significance as a potential diagnostic biomarker through its genetic underpinnings. This investigation establishes a solid base for subsequent experimental inquiries. Our findings introduce novel approaches for incorporating traditional Chinese medicine into the treatment of AS-IBD comorbidity, setting the stage for groundbreaking research directions.
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Affiliation(s)
- Xuhong Zhang
- Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, China
| | - Lamei Zhou
- Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, China
| | - Xian Qian
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Wang M, He X. Mendelian randomization analysis reveals causal associations of inflammatory bowel disease with Spondylarthritis. Gene 2024; 902:148170. [PMID: 38237812 DOI: 10.1016/j.gene.2024.148170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Inflammatory bowel disease (IBD) is strongly associated with Spondylarthritis (SpA), but the causal relationship remains unclear. This study explores the causal associations between IBD (Crohn's disease [CD] and ulcerative colitis [UC]) and several common subtypes of SpA (Ankylosing Spondylitis [AS], Psoriatic Arthritis [PsA], and Reactive Arthritis [ReA]), using bidirectional two-sample Mendelian randomization (TSMR). METHODS The causal effects of genetically predicted IBD on AS, PsA, and ReA were firstly investigated in this forward study. The causal effects from AS, PsA, and ReA on IBD were analyzed in the reverse MR. Inverse variance weighted, weighted median, and MR-Egger were applied in the MR analyses. The pleiotropic effects, heterogeneity, and leave-one-out sensitivity analysis were also evaluated. RESULTS The forward MR analysis demonstrated that IBD increased risk for AS (OR:1.278; P = 1.273 × 10-5), PsA (OR:1.192; P = 1.690 × 10-5), and ReA (OR:1.106; P = 1.524 × 10-3). Among them, CD increased risk of AS (OR:1.196; P = 3.424 × 10-4), PsA (OR:1.101; P = 1.537 × 10-3), ReA (OR:1.079; P = 6.321 × 10-3) whereas UC increased risk of AS (OR:1.166; P = 2.727 × 10-2), PsA (OR:1.110; P = 1.944 × 10-2), and ReA (OR:1.091; P = 1.768 × 10-2). The reverse-direction MR disclosed no notable association; neither was any evidence of pleiotropy detected. CONCLUSION Our study verifies a causal effect of IBD to AS, PsA as well as ReA, but not vice versa. This might bring new insights for the management of IBD and SpA in clinical practice.
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Affiliation(s)
- Min Wang
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Rheumatology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu 210029, China
| | - Xiaojin He
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Rheumatology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu 210029, China.
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3
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Ondrejčáková L, Gregová M, Bubová K, Šenolt L, Pavelka K. Serum biomarkers and their relationship to axial spondyloarthritis associated with inflammatory bowel diseases. Autoimmun Rev 2024; 23:103512. [PMID: 38168574 DOI: 10.1016/j.autrev.2023.103512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Abstract
Spondyloarthritis (SpA) constitute a group of chronic inflammatory immune-mediated rheumatic diseases characterized by genetic, clinical, and radiological features. Recent efforts have concentrated on identifying biomarkers linked to axial SpA associated with inflammatory bowel disease (IBD), offering predictive insights into disease onset, activity, and progression. Genetically, the significance of the HLA-B27 antigen is notably diminished in ankylosing spondylitis (AS) associated with IBD, but is heightened in concurrent sacroiliitis. Similarly, certain polymorphisms of endoplasmic reticulum aminopeptidase (ERAP-1) appear to be involved. Carriage of variant NOD2/CARD15 polymorphisms has been demonstrated to correlate with the risk of subclinical intestinal inflammation in AS. Biomarkers indicative of pro-inflammatory activity, including C-reactive protein (CRP) along with erythrocyte sedimentation rate (ESR), are among the consistent predictive biomarkers of disease progression. Nevertheless, these markers are not without limitations and exhibit relatively low sensitivity. Other promising markers encompass IL-6, serum calprotectin (s-CLP), serum amyloid (SAA), as well as biomarkers regulating bone formation such as metalloproteinase-3 (MMP-3) and Dickkopf-related protein 1 (DKK-1). Additional candidate indicators of structural changes in SpA patients include matrix metalloproteinase-3 (MMP-3), vascular endothelial growth factor (VEGF), tenascin C (TNC), and CD74 IgG. Fecal caprotein (f-CLP) levels over long-term follow-up of AS patients have demonstrated predictive value in anticipating the development of IBD. Serologic antibodies characteristic of IBD (ASCA, ANCA) have also been compared; however, results exhibit variability. In this review, we will focus on biomarkers associated with both axial SpA and idiopathic intestinal inflammation, notably enteropathic spondyloarthritis.
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Affiliation(s)
- L Ondrejčáková
- Institute of Rheumatology, Prague, Czech Republic; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - M Gregová
- Institute of Rheumatology, Prague, Czech Republic; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - K Bubová
- Institute of Rheumatology, Prague, Czech Republic; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - L Šenolt
- Institute of Rheumatology, Prague, Czech Republic; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - K Pavelka
- Institute of Rheumatology, Prague, Czech Republic; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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4
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Seymour BJ, Trent B, Allen BE, Berlinberg AJ, Tangchittsumran J, Jubair WK, Chriswell ME, Liu S, Ornelas A, Stahly A, Alexeev EE, Dowdell AS, Sneed SL, Fechtner S, Kofonow JM, Robertson CE, Dillon SM, Wilson CC, Anthony RM, Frank DN, Colgan SP, Kuhn KA. Microbiota-dependent indole production stimulates the development of collagen-induced arthritis in mice. J Clin Invest 2023; 134:e167671. [PMID: 38113112 PMCID: PMC10866668 DOI: 10.1172/jci167671] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
Altered tryptophan catabolism has been identified in inflammatory diseases like rheumatoid arthritis (RA) and spondyloarthritis (SpA), but the causal mechanisms linking tryptophan metabolites to disease are unknown. Using the collagen-induced arthritis (CIA) model, we identified alterations in tryptophan metabolism, and specifically indole, that correlated with disease. We demonstrated that both bacteria and dietary tryptophan were required for disease and that indole supplementation was sufficient to induce disease in their absence. When mice with CIA on a low-tryptophan diet were supplemented with indole, we observed significant increases in serum IL-6, TNF, and IL-1β; splenic RORγt+CD4+ T cells and ex vivo collagen-stimulated IL-17 production; and a pattern of anti-collagen antibody isotype switching and glycosylation that corresponded with increased complement fixation. IL-23 neutralization reduced disease severity in indole-induced CIA. Finally, exposure of human colonic lymphocytes to indole increased the expression of genes involved in IL-17 signaling and plasma cell activation. Altogether, we propose a mechanism by which intestinal dysbiosis during inflammatory arthritis results in altered tryptophan catabolism, leading to indole stimulation of arthritis development. Blockade of indole generation may present a unique therapeutic pathway for RA and SpA.
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Affiliation(s)
| | - Brandon Trent
- Division of Rheumatology, Department of Medicine, and
| | | | | | | | | | | | - Sucai Liu
- Division of Rheumatology, Department of Medicine, and
| | - Alfredo Ornelas
- Mucosal Inflammation Program and Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Andrew Stahly
- Division of Rheumatology, Department of Medicine, and
| | - Erica E. Alexeev
- Mucosal Inflammation Program and Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alexander S. Dowdell
- Mucosal Inflammation Program and Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sunny L. Sneed
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jennifer M. Kofonow
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles E. Robertson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stephanie M. Dillon
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cara C. Wilson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert M. Anthony
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel N. Frank
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sean P. Colgan
- Mucosal Inflammation Program and Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Tzaneti A, Athanasopoulou E, Fessatou S, Fotis L. Chronic Nonbacterial Osteomyelitis in Inflammatory Bowel Disease. Life (Basel) 2023; 13:2347. [PMID: 38137947 PMCID: PMC10745028 DOI: 10.3390/life13122347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Chronic nonbacterial osteomyelitis (CNO), also known as chronic recurrent multifocal osteomyelitis (CRMO), is a rare autoinflammatory bone disease primarily affecting children and adolescents. This review presents a comprehensive analysis of the intricate relationship between CNO and inflammatory bowel disease (IBD), shedding light on shared pathophysiological mechanisms and clinical management. A thorough literature review was conducted, encompassing 24 case reports involving 40 patients. The demographic distribution of patients revealed a near-equal gender ratio, with a median age of diagnosis at 12 years. The diagnosis patterns showed a higher proportion of CNO as the initial diagnosis, while Crohn's disease was more prevalent than ulcerative colitis. The time interval between the clinical presentations varied, ranging from simultaneous detection to a substantial 15-year gap. Treatment modalities included nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, aminosalicylates, and biologic agents, such as infliximab, often overlapping in their use and suggesting shared pathophysiological pathways. Both conditions displayed systemic manifestations, and patients often responded well to immunosuppressive medications. The pathophysiology of CNO involves a genetic predisposition, cytokine dysregulation, and osteoclast activation. Dysregulated innate immunity results in immune cell infiltration into bones, causing sterile bone lesions. Notably, emerging evidence hints at a potential link between the microbiome and CNO. In contrast, IBD results from imbalanced mucosal immune responses to the intestinal microbiota. Polymorphisms in the promotor region of IL-10, common cytokines, immune cells, and genetic markers indicate shared immunological and genetic factors between CNO and IBD. Both conditions also involve extraintestinal symptoms. This analysis underscores the need for clinical awareness of the co-occurrence of CNO and IBD, especially among pediatric patients. A deepened understanding of the connections between these seemingly distinct diseases could lead to more effective management and improved patient outcomes.
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Affiliation(s)
- Ariadni Tzaneti
- Department of Pediatrics, Attikon General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Elli Athanasopoulou
- Department of Pediatrics, Attikon General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Smaragdi Fessatou
- Division of Pediatric Gastroenterology, Department of Pediatrics, Attikon General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece;
| | - Lampros Fotis
- Division of Pediatric Rheumatology, Department of Pediatrics, Attikon General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece
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Bernal-Alferes B, Gómez-Mosqueira R, Ortega-Tapia GT, Burgos-Vargas R, García-Latorre E, Domínguez-López ML, Romero-López JP. The role of γδ T cells in the immunopathogenesis of inflammatory diseases: from basic biology to therapeutic targeting. J Leukoc Biol 2023; 114:557-570. [PMID: 37040589 DOI: 10.1093/jleuko/qiad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023] Open
Abstract
The γδ T cells are lymphocytes with an innate-like phenotype that can distribute to different tissues to reside and participate in homeostatic functions such as pathogen defense, tissue modeling, and response to stress. These cells originate during fetal development and migrate to the tissues in a TCR chain-dependent manner. Their unique manner to respond to danger signals facilitates the initiation of cytokine-mediated diseases such as spondyloarthritis and psoriasis, which are immune-mediated diseases with a very strong link with mucosal disturbances, either in the skin or the gut. In spondyloarthritis, γδ T cells are one of the main sources of IL-17 and, therefore, the main drivers of inflammation and probably new bone formation. Remarkably, this population can be the bridge between gut and joint inflammation.
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Affiliation(s)
- Brian Bernal-Alferes
- Laboratorio de Inmunoquímica 1, Posgrado en Ciencias Quimicobiológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Unidad Profesional Lázaro Cárdenas, Prolongación de Carpio y Plan de Ayala s/n, Col. Santo Tomás C.P. 11340 Alcaldía Miguel Hidalgo, Ciudad de México, México
| | - Rafael Gómez-Mosqueira
- Laboratorio de Inmunoquímica 1, Posgrado en Ciencias Quimicobiológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Unidad Profesional Lázaro Cárdenas, Prolongación de Carpio y Plan de Ayala s/n, Col. Santo Tomás C.P. 11340 Alcaldía Miguel Hidalgo, Ciudad de México, México
| | - Graciela Teresa Ortega-Tapia
- Laboratorio de Inmunoquímica 1, Posgrado en Ciencias Quimicobiológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Unidad Profesional Lázaro Cárdenas, Prolongación de Carpio y Plan de Ayala s/n, Col. Santo Tomás C.P. 11340 Alcaldía Miguel Hidalgo, Ciudad de México, México
| | - Rubén Burgos-Vargas
- Departamento de Reumatología, Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis No. 148 Col. Doctores C.P. 06720, Alcaldía Cuauhtémoc Ciudad de México, México
| | - Ethel García-Latorre
- Laboratorio de Inmunoquímica 1, Posgrado en Ciencias Quimicobiológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Unidad Profesional Lázaro Cárdenas, Prolongación de Carpio y Plan de Ayala s/n, Col. Santo Tomás C.P. 11340 Alcaldía Miguel Hidalgo, Ciudad de México, México
| | - María Lilia Domínguez-López
- Laboratorio de Inmunoquímica 1, Posgrado en Ciencias Quimicobiológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Unidad Profesional Lázaro Cárdenas, Prolongación de Carpio y Plan de Ayala s/n, Col. Santo Tomás C.P. 11340 Alcaldía Miguel Hidalgo, Ciudad de México, México
| | - José Pablo Romero-López
- Laboratorio de Patogénesis Molecular, Edificio A4, Red MEDICI, Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Avenida de los Barrios Número 1, Colonia Los Reyes Ixtacala, C.P. 54090, Tlalnepantla, Estado de México, México
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7
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Seymour BJ, Trent B, Allen B, Berlinberg AJ, Tangchittsumran J, Jubair WK, Chriswell ME, Liu S, Ornelas A, Stahly A, Alexeev EE, Dowdell AS, Sneed SL, Fechtner S, Kofonow JM, Robertson CE, Dillon SM, Wilson CC, Anthony RM, Frank DN, Colgan SP, Kuhn KA. Microbiota-dependent indole production is required for the development of collagen-induced arthritis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.13.561693. [PMID: 37873395 PMCID: PMC10592798 DOI: 10.1101/2023.10.13.561693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Altered tryptophan catabolism has been identified in inflammatory diseases like rheumatoid arthritis (RA) and spondyloarthritis (SpA), but the causal mechanisms linking tryptophan metabolites to disease are unknown. Using the collagen-induced arthritis (CIA) model we identify alterations in tryptophan metabolism, and specifically indole, that correlate with disease. We demonstrate that both bacteria and dietary tryptophan are required for disease, and indole supplementation is sufficient to induce disease in their absence. When mice with CIA on a low-tryptophan diet were supplemented with indole, we observed significant increases in serum IL-6, TNF, and IL-1β; splenic RORγt+CD4+ T cells and ex vivo collagen-stimulated IL-17 production; and a pattern of anti-collagen antibody isotype switching and glycosylation that corresponded with increased complement fixation. IL-23 neutralization reduced disease severity in indole-induced CIA. Finally, exposure of human colon lymphocytes to indole increased expression of genes involved in IL-17 signaling and plasma cell activation. Altogether, we propose a mechanism by which intestinal dysbiosis during inflammatory arthritis results in altered tryptophan catabolism, leading to indole stimulation of arthritis development. Blockade of indole generation may present a novel therapeutic pathway for RA and SpA.
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Affiliation(s)
- Brenda J. Seymour
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brandon Trent
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brendan Allen
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Adam J. Berlinberg
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jimmy Tangchittsumran
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Widian K. Jubair
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Meagan E. Chriswell
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sucai Liu
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alfredo Ornelas
- Mucosal Inflammation Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Stahly
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Erica E. Alexeev
- Mucosal Inflammation Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexander S. Dowdell
- Mucosal Inflammation Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sunny L. Sneed
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sabrina Fechtner
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer M. Kofonow
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Charles E. Robertson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stephanie M. Dillon
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cara C. Wilson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert M. Anthony
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel N. Frank
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sean P. Colgan
- Mucosal Inflammation Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristine A. Kuhn
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Thiran A, Petta I, Blancke G, Thorp M, Planckaert G, Jans M, Andries V, Barbry K, Gilis E, Coudenys J, Hochepied T, Vanhove C, Gracey E, Dumas E, Manuelo T, Josipovic I, van Loo G, Elewaut D, Vereecke L. Sterile triggers drive joint inflammation in TNF- and IL-1β-dependent mouse arthritis models. EMBO Mol Med 2023; 15:e17691. [PMID: 37694693 PMCID: PMC10565626 DOI: 10.15252/emmm.202317691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023] Open
Abstract
Arthritis is the most common extra-intestinal complication in inflammatory bowel disease (IBD). Conversely, arthritis patients are at risk for developing IBD and often display subclinical gut inflammation. These observations suggest a shared disease etiology, commonly termed "the gut-joint-axis." The clinical association between gut and joint inflammation is further supported by the success of common therapeutic strategies and microbiota dysbiosis in both conditions. Most data, however, support a correlative relationship between gut and joint inflammation, while causative evidence is lacking. Using two independent transgenic mouse arthritis models, either TNF- or IL-1β dependent, we demonstrate that arthritis develops independently of the microbiota and intestinal inflammation, since both lines develop full-blown articular inflammation under germ-free conditions. In contrast, TNF-driven gut inflammation is fully rescued in germ-free conditions, indicating that the microbiota is driving TNF-induced gut inflammation. Together, our study demonstrates that although common inflammatory pathways may drive both gut and joint inflammation, the molecular triggers initiating such pathways are distinct in these tissues.
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9
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Lin A, Tan Y, Chen J, Liu X, Wu J. Development of ankylosing spondylitis in patients with ulcerative colitis: A systematic meta-analysis. PLoS One 2023; 18:e0289021. [PMID: 37527250 PMCID: PMC10393153 DOI: 10.1371/journal.pone.0289021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/09/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Ulcerative colitis (UC) is a manifestation of inflammatory bowel disease (IBD), which can cause inflammation of the intestinal tract. Ankylosing spondylitis (AS) is an inflammatory disease of the sacroiliac joints. Many studies have found that some UC patients progress to AS. In this study, we conducted a literature search and meta-analysis to investigate the prevalence of AS among UC patients during follow-up. METHODS The studies related to the AS among patients with UC were obtained from PubMed, Web of Science, Embase, and Cochrane Library databases since its inception-December 2022. The literature was screened strictly according to inclusion and exclusion criteria. Forest plots were used to detect the overall incidence of AS in UC and to compare the risk ratios for the development of AS in the UC. The heterogeneity of studies was assessed using I2 statistical methods. RESULTS 1) 17 studies with 98704 UC patients were included. 2)700 UC patients developed AS during follow-up (1.66%, 95% CI: 0.89-2.62%). Human leukocyte antigen B27 (HLA-B27) was reported in 3 studies. HLA-B27 positivity was significantly higher than the incidence of HLA-B27 negativity in AS patients (68.29% vs 31.71%, P < 0.0001). There was significantly increased risk of AS development in HLA-B27 positive IBD patients (RR: 22.17, 95% CI: 11.79-41.66, P < 0.0001). 3)The definite follow-up time was reported in 12 studies (range: 0.3-40 years). After follow-up for ≥5 years, the incidence of AS among patients with UC was 1.75% (95% CI: 0.62-3.37%). Meanwhile, after follow-up for <5 years, the incidence of AS among patients with UC was 1.41% (95% CI: 0.65-2.37%) which was significant. CONCLUSION Patients with UC are more likely to develop AS in the future. Furthermore, the IBD patients are at a higher risk of AS who have positive HLA-B27. The incidence of AS increased with longer follow-up time.
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Affiliation(s)
- Aitao Lin
- Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Yongyi Tan
- Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Jinxia Chen
- Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Xiaoyu Liu
- Department of Rheumatology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Jinyu Wu
- Department of Rheumatology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
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10
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Cozzi G, Scagnellato L, Lorenzin M, Savarino E, Zingone F, Ometto F, Favero M, Doria A, Vavricka SR, Ramonda R. Spondyloarthritis with inflammatory bowel disease: the latest on biologic and targeted therapies. Nat Rev Rheumatol 2023:10.1038/s41584-023-00984-8. [PMID: 37386288 DOI: 10.1038/s41584-023-00984-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 07/01/2023]
Abstract
Spondyloarthritis (SpA) encompasses a heterogeneous group of chronic inflammatory diseases that can affect both axial and peripheral joints, tendons and entheses. Among the extra-articular manifestations, inflammatory bowel disease (IBD) is associated with considerable morbidity and effects on quality of life. In everyday clinical practice, treatment of these conditions requires a close collaboration between gastroenterologists and rheumatologists to enable early detection of joint and intestinal manifestations during follow-up and to choose the most effective therapeutic regimen, implementing precision medicine for each patient's subtype of SpA and IBD. The biggest issue in this field is the dearth of drugs that are approved for both diseases, as only TNF inhibitors are currently approved for the treatment of full-spectrum SpA-IBD. Janus tyrosine kinase inhibitors are among the most promising drugs for the treatment of peripheral and axial SpA, as well as for intestinal manifestations. Other therapies such as inhibitors of IL-23 and IL-17, phosphodiesterase 4 inhibitor, α4β7 integrin blockers and faecal microbiota transplantation seem to only be able to control some disease domains, or require further studies. Given the growing interest in the development of novel drugs to treat both conditions, it is important to understand the current state of the art and the unmet needs in the management of SpA-IBD.
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Affiliation(s)
- Giacomo Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Laura Scagnellato
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy
| | - Francesca Ometto
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Marta Favero
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zürich and Center for Gastroenterology and Hepatology, Zürich, Switzerland
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy.
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11
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Momen Majumder MS, Haq SA, Rasker JJ. Tofacitinib for the treatment of inflammatory bowel disease-associated arthritis: two case reports. J Med Case Rep 2023; 17:71. [PMID: 36855206 PMCID: PMC9976468 DOI: 10.1186/s13256-023-03796-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 01/30/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Musculoskeletal manifestations are common extraintestinal manifestations of inflammatory bowel disease. Tofacitinib is a Janus kinase inhibitor approved for treating rheumatoid arthritis and ulcerative colitis. There are limited data on the efficacy of tofacitinib in managing inflammatory bowel disease-associated arthritis. Here we report two patients with ulcerative colitis- and Crohn's disease-associated arthritis successfully responding to tofacitinib. CASES A 34-year-old Bangladeshi woman presented with lower limb polyarthritis for 7 years. Six months after the onset of polyarthritis, she developed abdominal pain with rectal bleeding. Colonoscopy and rectal biopsy findings confirmed ulcerative colitis. Ulcerative colitis associated arthritis was diagnosed. Treatment with sulfasalazine, etanercept, adalimumab, infliximab, and methotrexate gave no long-lasting remission. Methotrexate with mesalazine gave a partial response, and tofacitinib 5 mg twice per day was added. Her articular and abdominal symptoms improved within a month, and remission persisted till 24 months of follow-up, except a short-lasting mild flare at the seventh month. A 52-year-old Bangladeshi man had Crohn's disease for 5 years. He presented with a swollen left knee and pain in other joints. Laboratory showed positive HLA-B27. He was intolerant to sulfasalazine and experienced poor response to methotrexate. Due to his inability to afford anti-tumor necrosis factor, tofacitinib was initiated. His arthritis improved within a month, and he remained in remission up to the sixth month. CONCLUSIONS In a woman with ulcerative colitis associated arthritis, refractory to biologic therapy, both arthritis and colitis improved with tofacitinib. A patient with Crohn's disease-associated arthritis went into remission with tofacitinib. Tofacitinib may be effective in inflammatory bowel disease-associated arthritis.
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Affiliation(s)
| | - Syed Atiqul Haq
- grid.411509.80000 0001 2034 9320Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Johannes J. Rasker
- grid.6214.10000 0004 0399 8953Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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12
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Development of Inflammatory Bowel Disease in Children With Juvenile Idiopathic Arthritis Treated With Biologics. J Pediatr Gastroenterol Nutr 2023; 76:174-182. [PMID: 36399775 DOI: 10.1097/mpg.0000000000003656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of our study was to describe the distinct features of inflammatory bowel disease (IBD) in juvenile idiopathic arthritis (JIA) patients and to identify risk factors for its development. METHODS Data from the German biologics in pediatric rheumatology registry (Biologika in der Kinderrheumatologie) collected between 2001 and 2021 were analyzed retrospectively. RESULTS In 5009 JIA patients, 28 developed confirmed IBD before the age of 18 years: 23 (82.1%) with Crohn disease (CD), 4 (14.3%) with ulcerative colitis (UC), and 1 (3.6%) with IBD-unclassified (IBD-U). The incident rate of IBD during 20 years of observation was 0.56% (0.46% for CD, 0.08% for UC, and 0.02% for IBD-U), of whom 20.3% were HLA-B27 positive, 25% had enthesitis-related arthritis, and 14.3% psoriatic arthritis. Within 90 days before IBD diagnosis, 82.1% (n = 23) received treatment with etanercept (ETA), 39.3% (n = 11) non-steroidal anti-inflammatory drugs, 17.9% (n = 5) systemic corticosteroids, 8 (28.6%) methotrexate (MTX), 14.3% (n = 4) sulfasalazine, 10.7% (n = 3) leflunomide, and 3.6% (n = 1) adalimumab and infliximab, respectively. The incidence of IBD was lower in patients treated with MTX, but higher in patients treated with ETA except if ETA was combined with MTX. Also in patients on leflunomide or sulfasalazine, the IBD incidence was higher. CONCLUSIONS In our JIA cohort, an increased IBD incidence is observed compared to the general population, and the ratio of CD to UC is markedly higher hinting at a distinct phenotype of IBD. Pretreatment with MTX seems to be protective. Treatment with ETA does not prevent IBD development and JIA patients treated with leflunomide and sulfasalazine may be at an increased risk for IBD development.
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13
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Sudhakar P, Wellens J, Verstockt B, Ferrante M, Sabino J, Vermeire S. Holistic healthcare in inflammatory bowel disease: time for patient-centric approaches? Gut 2023; 72:192-204. [PMID: 36171081 DOI: 10.1136/gutjnl-2022-328221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/12/2022] [Indexed: 02/04/2023]
Abstract
Inflammatory bowel disease (IBD) is an emerging global disease characterised by chronic inflammation of the gastrointestinal tract. However, IBD is also manifested by several extraintestinal symptoms which, along with the intestinal symptoms, impact on the mental and emotional well-being of patients. Despite therapeutic advancements, only one-third of the diagnosed patients receiving approved medical treatments achieve short-term to medium-term remission. Consequently, patients who do not get successfully treated might resort to using complementary and alternative approaches to manage their symptoms, with or without consulting their treating clinician. Despite their possible potential, such approaches have various risks stemming from unknown adverse reactions and possible interference with medically approved therapies. In this study, we present the results of a well-performed literature review where we included randomised clinical trials which have assessed the efficacy of complementary approaches and dietary therapy on at least one of the following four outcomes: clinical remission, endoscopic remission, modulation of molecular biomarkers or quality of life metrics. By pointing out intraoutcome and interoutcome concordance, we identified possible candidates for clinical adoption and further study in larger randomised clinical trials covering the broad spectrum of IBD heterogeneity. We finally proposed a patient-centric clinical care model and a series of recommendations for stakeholders, with special attention to complementary approaches and dietary strategies, aimed at achieving holistic remission.
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Affiliation(s)
- Padhmanand Sudhakar
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Judith Wellens
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - João Sabino
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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14
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Li C, Wu Y, Xie Y, Zhang Y, Jiang S, Wang J, Luo X, Chen Q. Oral manifestations serve as potential signs of ulcerative colitis: A review. Front Immunol 2022; 13:1013900. [PMID: 36248861 PMCID: PMC9559187 DOI: 10.3389/fimmu.2022.1013900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
As an immune dysregulation-related disease, although ulcerative colitis (UC) primarily affects the intestinal tract, extraintestinal manifestations of the disease are evident, particularly in the oral cavity. Herein, we have reviewed the various oral presentations, potential pathogenesis, and treatment of oral lesions related to UC. The oral manifestations of UC include specific and nonspecific manifestations, with the former including pyostomatitis vegetans and the latter encompassing recurrent aphthous ulcers, atrophic glossitis, burning mouth syndrome, angular cheilitis, dry mouth, taste change, halitosis, and periodontitis. Although the aetiology of UC has not been fully determined, the factors leading to its development include immune system dysregulation, dysbiosis, and malnutrition. The principle of treating oral lesions in UC is to relieve pain, accelerate the healing of lesions, and prevent secondary infection, and the primary procedure is to control intestinal diseases. Systemic corticosteroids are the preferred treatment options, besides, topical and systemic administration combined with dietary guidance can also be applied. Oral manifestations of UC might accompany or precede the diagnosis of UC, albeit with the absence of intestinal symptoms; therefore, oral lesions, especially pyostomatitis vegetans, recurrent aphthous ulcer and periodontitis, could be used as good mucocutaneous signs to judge the occurrence and severity of UC, thus facilitating the early diagnosis and treatment of UC and avoiding severe consequences, such as colon cancer.
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Affiliation(s)
| | | | | | | | | | | | - Xiaobo Luo
- *Correspondence: Qianming Chen, ; Xiaobo Luo,
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15
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Wang Y, Hong C, Wu Z, Li S, Xia Y, Liang Y, He X, Xiao X, Tang W. Resveratrol in Intestinal Health and Disease: Focusing on Intestinal Barrier. Front Nutr 2022; 9:848400. [PMID: 35369090 PMCID: PMC8966610 DOI: 10.3389/fnut.2022.848400] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022] Open
Abstract
The integrity of intestinal barrier determines intestinal homeostasis, which could be affected by various factors, like physical, chemical, and biological stimuli. Therefore, it is of considerable interest and importance to maintain intestinal barrier function. Fortunately, many plant polyphenols, including resveratrol, could affect the health of intestinal barrier. Resveratrol has many biological functions, such as antioxidant, anti-inflammation, anti-tumor, and anti-cardiovascular diseases. Accumulating studies have shown that resveratrol affects intestinal tight junction, microbial composition, and inflammation. In this review, we summarize the effects of resveratrol on intestinal barriers as well as the potential mechanisms (e.g., inhibiting the growth of pathogenic bacteria and fungi, regulating the expression of tight junction proteins, and increasing anti-inflammatory T cells while reducing pro-inflammatory T cells), and highlight the applications of resveratrol in ameliorating various intestinal diseases.
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Affiliation(s)
- Youxia Wang
- College of Animal Science, South China Agricultural University, Guangzhou, China
| | - Changming Hong
- College of Animal Science, South China Agricultural University, Guangzhou, China
| | - Zebiao Wu
- College of Animal Science, South China Agricultural University, Guangzhou, China
| | - Shuwei Li
- Animal Breeding and Genetics Key Laboratory of Sichuan Province, Sichuan Animal Science Academy, Chengdu, China
- Livestock and Poultry Biological Products Key Laboratory of Sichuan Province, Sichuan Animtech Feed Co., Ltd., Chengdu, China
| | - Yaoyao Xia
- College of Animal Science, South China Agricultural University, Guangzhou, China
| | - Yuying Liang
- College of Animal Science, South China Agricultural University, Guangzhou, China
| | - Xiaohua He
- College of Animal Science, South China Agricultural University, Guangzhou, China
| | - Xinyu Xiao
- College of Animal Science, South China Agricultural University, Guangzhou, China
| | - Wenjie Tang
- Animal Breeding and Genetics Key Laboratory of Sichuan Province, Sichuan Animal Science Academy, Chengdu, China
- Livestock and Poultry Biological Products Key Laboratory of Sichuan Province, Sichuan Animtech Feed Co., Ltd., Chengdu, China
- *Correspondence: Wenjie Tang
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16
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Edwards V, Smith DL, Meylan F, Tiffany L, Poncet S, Wu WW, Phue JN, Santana-Quintero L, Clouse KA, Gabay O. Analyzing the Role of Gut Microbiota on the Onset of Autoimmune Diseases Using TNF ΔARE Murine Model. Microorganisms 2021; 10:73. [PMID: 35056521 PMCID: PMC8779571 DOI: 10.3390/microorganisms10010073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022] Open
Abstract
Very little is known about disease transmission via the gut microbiome. We hypothesized that certain inflammatory features could be transmitted via the gut microbiome and tested this hypothesis using an animal model of inflammatory diseases. Twelve-week-old healthy C57 Bl/6 and Germ-Free (GF) female and male mice were fecal matter transplanted (FMT) under anaerobic conditions with TNFΔARE-/+ donors exhibiting spontaneous Rheumatoid Arthritis (RA) and Inflammatory Bowel Disease (IBD) or with conventional healthy mice control donors. The gut microbiome analysis was performed using 16S rRNA sequencing amplification and bioinformatics analysis with the HIVE bioinformatics platform. Histology, immunohistochemistry, ELISA Multiplex analysis, and flow cytometry were conducted to confirm the inflammatory transmission status. We observed RA and IBD features transmitted in the GF mice cohort, with gut tissue disruption, cartilage alteration, elevated inflammatory mediators in the tissues, activation of CD4/CD8+ T cells, and colonization and transmission of the gut microbiome similar to the donors' profile. We did not observe a change or transmission when conventional healthy mice were FMT with TNFΔARE-/+ donors, suggesting that a healthy microbiome might withstand an unhealthy transplant. These findings show the potential involvement of the gut microbiome in inflammatory diseases. We identified a cluster of bacteria playing a role in this mechanism.
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Affiliation(s)
- Vivienne Edwards
- Division of Biotechnology Review and Research I, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Office of Biotechnology Products, Office of Pharmaceutical Quality, Silver Spring, MD 20993, USA; (V.E.); (D.L.S.); (L.T.); (S.P.); (K.A.C.)
| | - Dylan L. Smith
- Division of Biotechnology Review and Research I, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Office of Biotechnology Products, Office of Pharmaceutical Quality, Silver Spring, MD 20993, USA; (V.E.); (D.L.S.); (L.T.); (S.P.); (K.A.C.)
| | - Francoise Meylan
- Translational Immunology Section, NIH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20892, USA;
| | - Linda Tiffany
- Division of Biotechnology Review and Research I, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Office of Biotechnology Products, Office of Pharmaceutical Quality, Silver Spring, MD 20993, USA; (V.E.); (D.L.S.); (L.T.); (S.P.); (K.A.C.)
| | - Sarah Poncet
- Division of Biotechnology Review and Research I, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Office of Biotechnology Products, Office of Pharmaceutical Quality, Silver Spring, MD 20993, USA; (V.E.); (D.L.S.); (L.T.); (S.P.); (K.A.C.)
| | - Wells W. Wu
- Facility for Biotechnology Resources, Center for Biologicals Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; (W.W.W.); (J.-N.P.)
| | - Je-Nie Phue
- Facility for Biotechnology Resources, Center for Biologicals Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; (W.W.W.); (J.-N.P.)
| | - Luis Santana-Quintero
- U.S. Food and Drug Administration, Center for Biologics Evaluation & Research, Office of Biostatistics and Epidemiology, HIVE, Silver Spring, MD 20993, USA;
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Hematology and Oncology Products, Silver Spring, MD 20993, USA
| | - Kathleen A. Clouse
- Division of Biotechnology Review and Research I, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Office of Biotechnology Products, Office of Pharmaceutical Quality, Silver Spring, MD 20993, USA; (V.E.); (D.L.S.); (L.T.); (S.P.); (K.A.C.)
| | - Odile Gabay
- Division of Biotechnology Review and Research I, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Office of Biotechnology Products, Office of Pharmaceutical Quality, Silver Spring, MD 20993, USA; (V.E.); (D.L.S.); (L.T.); (S.P.); (K.A.C.)
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17
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Dushnicky MJ, Beattie KA, Cellucci T, Heale L, Zachos M, Sherlock M, Batthish M. Pediatric Patients with a Dual Diagnosis of Inflammatory Bowel Disease and Chronic Recurrent Multifocal Osteomyelitis. J Pediatr Gastroenterol Nutr 2021; 73:626-629. [PMID: 34238828 DOI: 10.1097/mpg.0000000000003225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
ABSTRACT There is a paucity of information about the epidemiology, pathophysiology, and treatment of patients with a dual diagnosis of inflammatory bowel disease (IBD) and chronic recurrent multifocal osteomyelitis (CRMO). A retrospective chart review was performed of patients at McMaster Children's Hospital with a diagnosis of either IBD or CRMO, to identify those with the dual diagnosis over a 10-year period. A dual diagnosis was identified in seven patients. Most patients (6/7) had a diagnosis of IBD first and were subsequently diagnosed with CRMO. At the time of CRMO diagnosis, IBD treatment regimens included one or more of, sulfasalazine (1/6), infliximab (3/6), adalimumab (1/6), or no treatment (1/6). Although the etiology of the link remains unknown, there does not seem to be an association to a specific IBD subtype, age, or treatment. Our patient population demonstrated a response to biologic agents, specifically tumor necrosis factor-α inhibitors, as treatment for both conditions.
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Affiliation(s)
| | | | | | - Liane Heale
- Division of Rheumatology, Department of Pediatrics
| | - Mary Zachos
- Division of Gastroenterology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mary Sherlock
- Division of Gastroenterology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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18
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Chia AYT, Ang GWX, Chan ASY, Chan W, Chong TKY, Leung YY. Managing Psoriatic Arthritis With Inflammatory Bowel Disease and/or Uveitis. Front Med (Lausanne) 2021; 8:737256. [PMID: 34604268 PMCID: PMC8481670 DOI: 10.3389/fmed.2021.737256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease that presents with psoriasis (PsO), peripheral and axial arthropathy. The heterogeneity of disease presentation leads to the term "psoriatic disease (PsD)" which is thought to better encompass the range of clinical manifestations. PsA is associated with several comorbidities such as cardiovascular diseases, metabolic syndrome and other extra-articular manifestations including uveitis, and inflammatory bowel disease (IBD). While novel therapeutics are being developed following advances in our understanding of the pathogenesis of the disease, the diverse combinations of PsA with its various comorbidities still pose a clinical challenge in managing patients with PsA. This article reviews our current understanding of the pathogenesis of PsA and how various pathways in the pathogenesis lead to the two comorbid extra-articular manifestations - uveitis and IBD. We also review current evidence of treatment strategies in managing patients with PsA with comorbidities of uveitis and/or IBD.
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Affiliation(s)
- Alfred Yu Ting Chia
- Duke-NUS Medical School, Singapore, Singapore
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Gladys Wei Xin Ang
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Anita Sook Yee Chan
- Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Center and Singapore Eye Research Center, Singapore, Singapore
| | - Webber Chan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | | | - Ying Ying Leung
- Duke-NUS Medical School, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
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19
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Larussa T, Basile A, Palleria C, Iannelli C, Vero A, Giubilei L, De Sarro C, Suraci E, Marasco R, Imeneo M, Russo E, Abenavoli L, De Sarro G, Luzza F. Real-life burden of adverse reactions to biological therapy in inflammatory bowel disease: a single-centre prospective case series. Med Pharm Rep 2021; 94:289-297. [PMID: 34430850 DOI: 10.15386/mpr-1897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/20/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Background/aim Biologics represent a key therapeutic option in inflammatory bowel disease (IBD), but are associated with several side effects. Post-marketing surveillance, through a spontaneous adverse drug reactions (ADRs) monitoring system, is essential to assess the safety profile of biologics. The aim of the study was to prospectively evaluate the occurrence of ADRs in IBD patients treated with biologics from a single centre in Southern Italy. Methods Data from patients with Crohn's Disease (CD) and Ulcerative Colitis (UC) who underwent biological therapy were prospectively collected. ADRs were classified according to the Medical Dictionary for Regulatory Activities (MedDRA®). Results Overall, 68 (54% male, 68% with UC and 32% with CD) biologic-naïve IBD patients underwent biological therapy. Mean follow-up was 11.7 ± 6.2 months. As a results of switches, for 68 patients we obtained 96 biologic prescriptions. Overall, 45 ADRs occurred in 36 (53%) patients, distributed as follows (ADRs/prescriptions): 19/37 with IFX-Remicade, 5/12 with IFX-Remsima, 8/9 with GOL, 11/26 with ADA, and 2/12 with VDZ. Mild ADRs were 29 (64%), moderate 15 (34%) and 1 (2%) severe. General disorders and administration related reactions were the most frequent ADRs (35%), followed by skin and subcutaneous tissue disorders (20%), infections (15%), musculoskeletal (11%), respiratory (6%) blood (4%), gastrointestinal (4%), and vascular disorders (2%). In 9 cases (20%) the ADRs resulted in definitive discontinuation of biologic therapy. Conclusion In a prospective cohort of IBD patients, more than half experienced ADRs during biologic therapy. General disorders and administration related reactions were the most common ADRs, while infections were less common and rarely led to discontinuation of therapy. Findings underline the importance of surveillance in management of IBD patients during biologic therapy and implementing safety protocols with data from real-life settings.
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Affiliation(s)
- Tiziana Larussa
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Antonio Basile
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Caterina Palleria
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Chiara Iannelli
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Ada Vero
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Lidia Giubilei
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Caterina De Sarro
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Evelina Suraci
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Raffaella Marasco
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Maria Imeneo
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Emilio Russo
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | | | - Francesco Luzza
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
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20
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Hunter ML, Knuiman MW, Musk BAW, Hui J, Murray K, Beilby JP, Hillman DR, Hung J, Newton RU, Bucks RS, Straker L, Walsh JP, Zhu K, Bruce DG, Eikelboom RH, Davis TME, Mackey DA, James AL. Prevalence and patterns of multimorbidity in Australian baby boomers: the Busselton healthy ageing study. BMC Public Health 2021; 21:1539. [PMID: 34380465 PMCID: PMC8359115 DOI: 10.1186/s12889-021-11578-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Chronic medical conditions accumulate within individuals with age. However, knowledge concerning the trends, patterns and determinants of multimorbidity remains limited. This study assessed the prevalence and patterns of multimorbidity using extensive individual phenotyping in a general population of Australian middle-aged adults. METHODS Participants (n = 5029, 55% female), born between 1946 and 1964 and attending the cross-sectional phase of the Busselton Healthy Ageing Study (BHAS) between 2010 and 2015, were studied. Prevalence of 21 chronic conditions was estimated using clinical measurement, validated instrument scores and/or self-reported doctor-diagnosis. Non-random patterns of multimorbidity were explored using observed/expected (O/E) prevalence ratios and latent class analysis (LCA). Variables associated with numbers of conditions and class of multimorbidity were investigated. RESULTS The individual prevalence of 21 chronic conditions ranged from 2 to 54% and multimorbidity was common with 73% of the cohort having 2 or more chronic conditions. (mean ± SD 2.75 ± 1.84, median = 2.00, range 0-13). The prevalence of multimorbidity increased with age, obesity, physical inactivity, tobacco smoking and family history of asthma, diabetes, myocardial infarct or cancer. There were 13 pairs and 27 triplets of conditions identified with a prevalence > 1.5% and O/E > 1.5. Of the triplets, arthritis (> 50%), bowel disease (> 33%) and depression-anxiety (> 33%) were observed most commonly. LCA modelling identified 4 statistically and clinically distinct classes of multimorbidity labelled as: 1) "Healthy" (70%) with average of 1.95 conditions; 2) "Respiratory and Atopy" (11%, 3.65 conditions); 3) "Non-cardiometabolic" (14%, 4.77 conditions), and 4) "Cardiometabolic" (5%, 6.32 conditions). Predictors of multimorbidity class membership differed between classes and differed from predictors of number of co-occurring conditions. CONCLUSION Multimorbidity is common among middle-aged adults from a general population. Some conditions associated with ageing such as arthritis, bowel disease and depression-anxiety co-occur in clinically distinct patterns and at higher prevalence than expected by chance. These findings may inform further studies into shared biological and environmental causes of co-occurring conditions of ageing. Recognition of distinct patterns of multimorbidity may aid in a holistic approach to care management in individuals presenting with multiple chronic conditions, while also guiding health resource allocation in ageing populations.
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Affiliation(s)
- Michael L Hunter
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia.
- School of Population and Global Health, The University of Western Australia, Crawley, WA, 6009, Australia.
- BPMRI Busselton Health Study Centre, PO Box 659, Busselton, Western Australia, 6280.
| | - Matthew W Knuiman
- School of Population and Global Health, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Bill A W Musk
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Jennie Hui
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, WA, 6009, Australia
- PathWest Laboratory Medicine of WA, QEII Medical Centre, Nedlands, WA, 6009, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, WA, 6009, Australia
| | - John P Beilby
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia
- PathWest Laboratory Medicine of WA, QEII Medical Centre, Nedlands, WA, 6009, Australia
| | - David R Hillman
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Joseph Hung
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Crawley, 6009, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, 6027, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, WA, 6083, Australia
| | - Leon Straker
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, 6845, Australia
| | - John P Walsh
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Crawley, 6009, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Kun Zhu
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Crawley, 6009, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - David G Bruce
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Crawley, 6009, Australia
| | - Robert H Eikelboom
- Ear Science Institute Australia, Subiaco, WA, 6008, Australia
- Ear Sciences Centre, The University of Western Australia, Crawley, WA, Australia
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Timothy M E Davis
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, WA, 6959, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science, University of Western Australia, Lions Eye Institute, Perth, Australia
| | - Alan L James
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
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21
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Evans J, Sapsford M, McDonald S, Poole K, Raine T, Jadon DR. Prevalence of axial spondyloarthritis in patients with inflammatory bowel disease using cross-sectional imaging: a systematic literature review. Ther Adv Musculoskelet Dis 2021; 13:1759720X21996973. [PMID: 33786068 PMCID: PMC7958176 DOI: 10.1177/1759720x21996973] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/01/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) have an excess burden of axial spondyloarthritis (axSpA), which, if left untreated, may significantly impact on clinical outcomes. We aimed to estimate the prevalence of axSpA, including previously undiagnosed cases, in IBD patients from studies involving cross-sectional imaging and identify the IBD features potentially associated with axSpA. METHODS PubMed, Embase and Cochrane databases were searched systematically between 1990 and 2018. Article reference lists and key conference abstract lists from 2012 to 2018 were also reviewed. All abstracts were reviewed by two authors to determine eligibility for inclusion. The study inclusion criteria were (a) adults aged 18 years or above, (b) a clinical diagnosis of IBD and (c) reporting identification of sacroiliitis using cross-sectional imaging. RESULTS A total of 20 observational studies were identified: 12 used CT, 6 used MR and 2 utilised both computed tomography (CT) and magnetic resonance (MR) imaging. Sample sizes ranged from 25 to 1247 (a total of 4096 patients); 31 studies were considered to have low selection bias, 13 included two or more radiology readers, and 3 included rheumatological assessments. The prevalence of sacroiliitis, the most commonly reported axSpA feature, ranged from 2.2% to 68.0% with a pooled prevalence of 21.0% [95% confidence interval (CI) 17-26%]. Associated IBD features include increasing IBD duration, increasing age, male sex, IBD location, inflammatory back pain and peripheral arthritis. No significant difference in the prevalence of sacroiliitis between Crohn's disease and ulcerative colitis was identified. Study limitations include variability in the individual study sample sizes and patient demographics. CONCLUSION This review highlights the need for larger, well-designed studies using more sensitive imaging modalities and multivariable modelling to better estimate the prevalence of axSpA in IBD. An improved knowledge of the IBD phenotype(s) associated with axSpA and use of cross-sectional imaging intended for IBD assessment to screen for axSpA may help clinicians identify those patients most at risk.
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Affiliation(s)
- Jobie Evans
- Department of Rheumatology, Cambridge University
Hospitals NHSFT, Hills Road, Cambridge, CB2 0QQ, UK
- Department of Medicine, University of Cambridge,
Cambridge, UK
| | - Mark Sapsford
- North Shore Hospital, Waitemata District Health
Board, Auckland, New Zealand
| | - Scott McDonald
- Department of Radiology, Cambridge University
Hospitals NHSFT, Cambridge, UK
| | - Kenneth Poole
- Department of Rheumatology, Cambridge University
Hospitals NHSFT, Cambridge, UK
- Department of Medicine, University of Cambridge,
Cambridge, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge
University Hospitals NHSFT, Cambridge, UK
| | - Deepak R. Jadon
- Department of Rheumatology, Cambridge University
Hospitals NHSFT, Cambridge, UK
- Department of Medicine, University of Cambridge,
Cambridge, UK
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22
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Berlinberg AJ, Regner EH, Stahly A, Brar A, Reisz JA, Gerich ME, Fennimore BP, Scott FI, Freeman AE, Kuhn KA. Multi 'Omics Analysis of Intestinal Tissue in Ankylosing Spondylitis Identifies Alterations in the Tryptophan Metabolism Pathway. Front Immunol 2021; 12:587119. [PMID: 33746944 PMCID: PMC7966505 DOI: 10.3389/fimmu.2021.587119] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/08/2021] [Indexed: 12/20/2022] Open
Abstract
Intestinal microbial dysbiosis, intestinal inflammation, and Th17 immunity are all linked to the pathophysiology of spondyloarthritis (SpA); however, the mechanisms linking them remain unknown. One potential hypothesis suggests that the dysbiotic gut microbiome as a whole produces metabolites that influence human immune cells. To identify potential disease-relevant, microbiome-produced metabolites, we performed metabolomics screening and shotgun metagenomics on paired colon biopsies and fecal samples, respectively, from subjects with axial SpA (axSpA, N=21), Crohn's disease (CD, N=27), and Crohn's-axSpA overlap (CD-axSpA, N=12), as well as controls (HC, N=24). Using LC-MS based metabolomics of 4 non-inflamed pinch biopsies of the distal colon from subjects, we identified significant alterations in tryptophan pathway metabolites, including an expansion of indole-3-acetate (IAA) in axSpA and CD-axSpA compared to HC and CD and indole-3-acetaldehyde (I3Ald) in axSpA and CD-axSpA but not CD compared to HC, suggesting possible specificity to the development of axSpA. We then performed shotgun metagenomics of fecal samples to characterize gut microbial dysbiosis across these disease states. In spite of no significant differences in alpha-diversity among the 4 groups, our results confirmed differences in gene abundances of numerous enzymes involved in tryptophan metabolism. Specifically, gene abundance of indolepyruvate decarboxylase, which generates IAA and I3Ald, was significantly elevated in individuals with axSpA while gene abundances in HC demonstrated a propensity towards tryptophan synthesis. Such genetic changes were not observed in CD, again suggesting disease specificity for axSpA. Given the emerging role of tryptophan and its metabolites in immune function, altogether these data indicate that tryptophan metabolism into I3Ald and then IAA is one mechanism by which the gut microbiome potentially influences the development of axSpA.
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Affiliation(s)
- Adam J. Berlinberg
- Division of Rheumatology, Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Emilie H. Regner
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Andrew Stahly
- Division of Rheumatology, Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Ana Brar
- Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Julie A. Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado, Aurora, CO, United States
| | - Mark E. Gerich
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Blair P. Fennimore
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Frank I. Scott
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Alison E. Freeman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Kristine A. Kuhn
- Division of Rheumatology, Department of Medicine, University of Colorado, Aurora, CO, United States
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23
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Qaiyum Z, Lim M, Inman RD. The gut-joint axis in spondyloarthritis: immunological, microbial, and clinical insights. Semin Immunopathol 2021; 43:173-192. [PMID: 33625549 DOI: 10.1007/s00281-021-00845-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
The strong genetic and clinical overlaps between spondyloarthritis (SpA) and inflammatory bowel disease (IBD) have placed much needed focus on the gut-joint axis of inflammation in SpA, leading to three key hypotheses that attempt to unravel this complex relationship. The arthritogenic peptide hypothesis and the aberrant cellular trafficking hypothesis have been put forth to rationalize the manner by which the innate and adaptive immune systems cooperate and converge during SpA pathogenesis. The bacterial dysbiosis hypothesis discusses how changes in the microbiome lead to architectural and immunological consequences in SpA. These theories are not mutually exclusive, but can provide an explanation as to why subclinical gut inflammation may sometimes precede joint inflammation in SpA patients, thereby implying a causal relationship. Such investigations will be important in informing therapeutic decisions which may be common to both SpA and IBD. However, these hypotheses can also offer insights for a coincident inflammatory relationship between the gut and the joint, particularly when assessing the immunological players involved. Insights from understanding how these systems might affect the gut and joint differently will be equally imperative to address where the therapeutic differences lie between the two diseases. Collectively, this knowledge has practical implications in predicting the likelihood of IBD development in SpA or presence of coincident SpA-IBD, uncovering novel therapeutic targets, and redesigning currently approved treatments. It is evident that a multidisciplinary approach between the rheumatology and gastroenterology fields cannot be ignored, when it comes to the care of SpA patients at risk of IBD or vice versa.
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Affiliation(s)
- Zoya Qaiyum
- Schroeder Arthritis Institute, University Health Network, 60 Leonard Avenue, 5, Toronto, Ontario, KD-408, Canada
| | - Melissa Lim
- Schroeder Arthritis Institute, University Health Network, 60 Leonard Avenue, 5, Toronto, Ontario, KD-408, Canada
| | - Robert D Inman
- Schroeder Arthritis Institute, University Health Network, 60 Leonard Avenue, 5, Toronto, Ontario, KD-408, Canada.
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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24
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Byrd KM, Gulati AS. The "Gum-Gut" Axis in Inflammatory Bowel Diseases: A Hypothesis-Driven Review of Associations and Advances. Front Immunol 2021; 12:620124. [PMID: 33679761 PMCID: PMC7933581 DOI: 10.3389/fimmu.2021.620124] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/05/2021] [Indexed: 12/18/2022] Open
Abstract
In modern medicine, the oral cavity has often been viewed as a passive conduit to the upper airways and gastrointestinal tract; however, its connection to the rest of the body has been increasingly explored over the last 40 years. For several diseases, the periodontium and gingiva are at the center of this oral-systemic link. Over 50 systemic conditions have been specifically associated with gingival and periodontal inflammation, including inflammatory bowel diseases (IBD), which have recently been elevated from simple "associations" to elegant, mechanistic investigations. IBD and periodontitis have been reported to impact each other's progression via a bidirectional relationship whereby chronic oral or intestinal inflammation can impact the other; however, the precise mechanisms for how this occurs remain unclear. Classically, the etiology of gingival inflammation (gingivitis) is oral microbial dysbiosis in the subgingival crevice that can lead to destructive periodontal disease (periodontitis); however, the current understanding of gingival involvement in IBD is that it may represent a separate disease entity from classical gingivitis, arising from mechanisms related to systemic inflammatory activation of niche-resident immune cells. Synthesizing available evidence, we hypothesize that once established, IBD can be driven by microbiomial and inflammatory changes originating specifically from the gingival niche through saliva, thereby worsening IBD outcomes and thus perpetuating a vicious cycle. In this review, we introduce the concept of the "gum-gut axis" as a framework for examining this reciprocal relationship between the periodontium and the gastrointestinal tract. To support and explore this gum-gut axis, we 1) provide a narrative review of historical studies reporting gingival and periodontal manifestations in IBD, 2) describe the current understanding and advances for the gum-gut axis, and 3) underscore the importance of collaborative treatment and research plans between oral and GI practitioners to benefit this patient population.
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Affiliation(s)
- Kevin M. Byrd
- Division of Oral & Craniofacial Health Sciences, University of North Carolina Adams School of Dentistry, Chapel Hill, NC, United States
- Department of Innovation & Technology Research, ADA Science & Research Institute, Gaithersburg, MD, United States
| | - Ajay S. Gulati
- Division of Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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25
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Yamamoto-Furusho JK, Sánchez-Morales GE. Factors Associated with the Presence of Extraintestinal Manifestations in Patients with Ulcerative Colitis in a Latin American Country. Inflamm Intest Dis 2020; 5:200-204. [PMID: 33313072 DOI: 10.1159/000510070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background and Aim Ulcerative colitis (UC) is a subtype of inflammatory bowel disease that can develop extraintestinal manifestations (EIMs) in a subgroup of patients. The aim of this work was to study the frequency and clinical factors associated with the development of EIMs. Methods We evaluated a total of 260 Mexican patients with confirmed UC who were followed retrospectively in order to identify the factors associated with the presence of EIMs. Results The frequency of EIM was 55.8%. The factors associated with the development of EIM were pancolitis (p = 0.003, OR = 2.44, 95% CI = 1.34-4.56) and previous colectomy (p = 0.024, OR = 7.54, 95% CI = 1.20-60.44). A clinical course of initial activity and then long remission for >5 years was found to be a protective factor (p = 0.002, OR = 0.31, 95% CI = 0.14-0.67). Conclusion The frequency of EIM was 55.8% in our population, and the factors associated with their development were pancolitis and colectomy; meanwhile, a clinical course of initial activity and then long remission was a protector feature.
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Affiliation(s)
- Jesús K Yamamoto-Furusho
- Inflammatory Bowel Disease Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Germán E Sánchez-Morales
- Inflammatory Bowel Disease Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
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26
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Inflammatory Bowel Diseases and Coexisting Spondyloarthritis: A Neglected and too Often Under-Reported Association by Radiologists. A Multicenter Study by Italian Research Group of Imaging in Rheumatology. GASTROENTEROLOGY INSIGHTS 2020. [DOI: 10.3390/gastroent11020008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the prevalence and the underreporting rate of sacroiliitis (SI) in a large cohort of patients with biopsy-proved Crohn’s disease (CD) who underwent magnetic resonance enterography (MRE) or computed tomography enterography (CTE). Materials and Methods: Patients with CD were recruited from eight Italian health centers in the period from January 2013 to December 2017. Disease activity was recorded according to the CD activity index (CDAI). The scans were read by two blinded readers who defined the presence of SI according to Assessment of SpondyloArthritis International Society (ASAS) classifications and European League Against Rheumatism (EULAR) recommendations. Moreover, SI was scored using a simplified Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. Results: Interobserver agreement in diagnosing SI on imaging was good (K = 0.72–0.83). SI was diagnosed in 129 (14.4%, 54 men, 75 women) out of 894 patients; however, sacroiliac joint (SIJ) abnormalities were not mentioned in the radiological reports of 112 patients (86%). Fifty (38.7%) out of 129 patients also underwent a subsequent SIJ evaluation through a dedicated MRI protocol to confirm SI. SI was found in a higher percentage of patients with “active” than “inactive” CD (18% vs. 4%). Conclusion: This study confirms the feasibility of CTE and MRE for the screening of SI in CD patients; however, it also underlines the remarkable problem concerning the underreporting of this entity in radiological practice.
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27
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Cui Z, Hou G, Meng X, Feng H, He B, Tian Y. Bidirectional Causal Associations Between Inflammatory Bowel Disease and Ankylosing Spondylitis: A Two-Sample Mendelian Randomization Analysis. Front Genet 2020; 11:587876. [PMID: 33329731 PMCID: PMC7710797 DOI: 10.3389/fgene.2020.587876] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background Associations between inflammatory bowel disease (IBD) [including ulcerative colitis (UC) and Crohn’s disease (CD)] and ankylosing spondylitis (AS) were discovered in observational studies, but no evidence supported the causal relationship between the two diseases. Methods We employed two-sample Mendelian randomization (MR) to estimate the unconfounded bidirectional causal associations between IBD (including UC and CD) and AS. We selected single-nucleotide polymorphisms (SNPs) from genome-wide association studies (GWAS) after strictly assessing the quality of the studies in the IEU GWAS database. Sensitivity analyses were also conducted to verify whether heterogeneity and pleiotropy can bias the MR results. Results We found positive causal effects of genetically increased UC, CD, and IBD risk on AS (e.g., UC and AS, IVW OR: 1.0256, 95% CI: 1.0130∼1.0385, p = 6.43E-05). However, we did not find significant causal associations of AS with UC, CD, or IBD (e.g., AS and UC, IVW OR: 1.1858, 95% CI: 0.8639∼1.6278, p = 0.2916). The sensitivity analysis also confirmed that horizontal pleiotropy was unlikely to bias the causality (e.g., UC and AS, MR-Egger: intercept p = 0.1326). The leave-one-out analysis also demonstrated that the observed links were not driven by SNP. No evidence of heterogeneity was found between the genetic variants (e.g., UC and AS, MR-Egger: Q statistic = 43.1297, I2<0.0001, p = 0.7434). Conclusion Our results provide new evidence indicating there are positive causal effects of IBD on AS in the European population. We suggest that the features of inflammatory bowel disease in particular should be assessed in the diagnosis of ankylosing spondylitis. We also provide some advice for preventing and treating the two diseases.
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Affiliation(s)
- Zhiyong Cui
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, China.,Peking University Health Science Center, Beijing, China
| | - Guojin Hou
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, China
| | - Xiangyu Meng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hui Feng
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, China
| | - Baichuan He
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, China
| | - Yun Tian
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, China
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28
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Giani T, Bernardini A, Basile M, Di Maurizo M, Perrone A, Renzo S, Filistrucchi V, Cimaz R, Lionetti P. Usefulness of magnetic resonance enterography in detecting signs of sacroiliitis in young patients with inflammatory bowel disease. Pediatr Rheumatol Online J 2020; 18:42. [PMID: 32493352 PMCID: PMC7268528 DOI: 10.1186/s12969-020-00433-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Arthritis is often an underestimated extraintestinal manifestation in pediatric inflammatory bowel disease (IBD), including sacroiliitis, whose early signs are well detectable at magnetic resonance imaging (MRI). Magnetic resonance enterography (MRE) is an accurate imaging modality for pediatric IBD assessment. We studied the possibility to detect signs of sacroiliac inflammation in a group of children with IBD who underwent MRE for gastrointestinal disease evaluation. METHODS We retrospectively reviewed MRE scans performed in pediatric patients with IBD. We looked for signs of sacroiliitis taking the ASAS (Assessment of SpondyloArthritis international Society) criteria as a model. Presence of bone marrow edema (using T2W sequences with fat suppression), diffusion restriction in Diffusion Weighted Imaging (DWI) or Diffusion Weighted Imaging with Background Suppression (DWIBS), and dynamic contrast enhancement were evaluated. Each SI joint was divided into 4 quadrants: upper iliac, lower iliac, upper sacral, and lower sacral. Two blinded observers with experience in pediatric and skeletal imaging independently evaluated the images. Cases upon which there was a disagreement were evaluated by the two reviewing radiologists and a third radiologist with similar experience together. RESULTS We enrolled 34 patients (24 males and 10 females, with mean age at scanning 14.3 years, median 15.3 years; 2 affected by ulcerative colitis, 32 by Crohn's disease) for a total of 59 examinations performed at the time of their first diagnosis or at symptom exacerbations. No patient complained of musculoskeletal symptoms, neither had pathological findings at articular examination. At the time of MRE 25 patients were under treatment for their IBD. Five patients had radiological signs of SI inflammation at MRE, albeit of mild degree. All patients with SI joint edema also had a restricted diffusion in DWIBS or DWI and almost everyone had contrast media uptake. CONCLUSIONS Sacroiliitis is one of the extraintestinal manifestation associated with IBD; it is often asymptomatic and clinically underdetected, with an unrelated progression with respect to the underlying IBD. MRE offers the possibility to study SI joints in young patients with IBD who undergo MRE for the investigation of their intestinal condition. Furthermore, we observed that gadolinium enhancement does not improve diagnostic specificity in sacroiliiitis detection.
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Affiliation(s)
- Teresa Giani
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy ,grid.9024.f0000 0004 1757 4641Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Azzurra Bernardini
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Massimo Basile
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Marco Di Maurizo
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Anna Perrone
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Sara Renzo
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Viola Filistrucchi
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health and Research Center for Adult and Rheumatic Diseases, University of Milan, Milan, Italy.
| | - Paolo Lionetti
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy ,grid.8404.80000 0004 1757 2304Neurofarba Department, University of Florence, Florence, Italy
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Ben Nessib D, Ferjani H, Maatallah K, Rahmouni S, Kaffel D, Hamdi W. Update on therapeutic management of spondyloarthritis associated with inflammatory bowel disease. Clin Rheumatol 2020; 39:3543-3553. [PMID: 32424656 DOI: 10.1007/s10067-020-05136-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 02/06/2023]
Abstract
Management of spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) remains a challenging task that requires multidisciplinary collaboration. Separate guidelines for each disease are well-established. However, the management of SpA co-occurring with Crohn's disease (CD) or ulcerative colitis (UC) has hardly been studied. There are few specific reports that focus on this therapeutic area. The main issue is that some therapeutic options used to treat one disease can negatively influence the other disease course. This study aims to evaluate the therapeutic alternatives that would allow for the appropriate management of patients with both SpA and IBD. Key Points • Collaboration between gastroenterologists and rheumatologists is recommended to improve the management of patients with spondyloarthritis (SpA) and inflammatory bowel disease (IBD). • When treating SpA occurring simultaneously with IBD, it would be appropriate to give priority to the active disease. • Considering its well-proven efficacy in both conditions, anti-tumor necrosis factor (TNF) therapy remains the corner stone in the treatment of these patients. • Other therapeutic options such as Janus kinases (JAK) inhibitors, interleukin (IL)-23 and IL-12 inhibitors, and vedolizumab are still under investigation.
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Affiliation(s)
- Dorra Ben Nessib
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia. .,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia. .,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia.
| | - Hanene Ferjani
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia
| | - Kaouther Maatallah
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia
| | - Safa Rahmouni
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia
| | - Dhia Kaffel
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia
| | - Wafa Hamdi
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia
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Abstract
Human leukocyte antigen (HLA) B27 is the key laboratory parameter for axial spondyloarthritis (axSpA). Its prevalence is variable across different geographic zones and ethnicities, and often mirrors the prevalence of axSpA. HLA-B27 plays a role in axSpA physiopathology. It is correlated with spondyloarthritis phenotype with a consistent positive association with family history, early disease onset, shorter diagnostic delay, hip involvement, and acute anterior uveitis. HLA-B27 has a pivotal role in many referral strategies. However, these strategies were developed in European populations and need to be evaluated in populations with lower HLA-B27 background prevalence, and where additional parameters might be needed.
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31
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Kathania M, Tsakem EL, Theiss AL, Venuprasad K. Gut Microbiota Contributes to Spontaneous Colitis in E3 Ligase Itch-Deficient Mice. THE JOURNAL OF IMMUNOLOGY 2020; 204:2277-2284. [PMID: 32169841 DOI: 10.4049/jimmunol.1701478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/10/2020] [Indexed: 12/16/2022]
Abstract
Inflammatory bowel diseases are associated with complex shifts in microbiota composition. However, it remains unclear whether specific subsets of commensal bacteria induce inflammatory bowel diseases in genetically susceptible hosts. In this study, we found that deficiency of the E3 ligase Itch, which leads to spontaneous colitis and rectal prolapse, is associated with alteration of the gut microbiota. 16S rRNA sequencing showed expansion of colitogenic Bacteroides sp. in Itch-/- mice. Treatment with broad-spectrum antibiotics substantially reduced colonic inflammation in Itch-/- mice. Microbiota of Itch-/- mice failed to induce spontaneous colitis upon transfer to Itch+/+ mice but aggravated chemically induced colitis. Furthermore, we found that Bacteroides vulgatus, which is expanded in Itch-/- mice, was sufficient to induce colon inflammation in Itch-/- mice.
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Affiliation(s)
- Mahesh Kathania
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390.,Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75390; and
| | - Elviche L Tsakem
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390.,Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75390; and
| | - Arianne L Theiss
- Division of Gastroenterology and Hepatology, School of Medicine at the Anschutz Medical Campus, University of Colorado, Aurora, CO 80045
| | - K Venuprasad
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390; .,Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75390; and
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32
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Mechanisms Underlying Bone Loss Associated with Gut Inflammation. Int J Mol Sci 2019; 20:ijms20246323. [PMID: 31847438 PMCID: PMC6940820 DOI: 10.3390/ijms20246323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/29/2019] [Accepted: 12/10/2019] [Indexed: 12/11/2022] Open
Abstract
Patients with gastrointestinal diseases frequently suffer from skeletal abnormality, characterized by reduced bone mineral density, increased fracture risk, and/or joint inflammation. This pathological process is characterized by altered immune cell activity and elevated inflammatory cytokines in the bone marrow microenvironment due to disrupted gut immune response. Gastrointestinal disease is recognized as an immune malfunction driven by multiple factors, including cytokines and signaling molecules. However, the mechanism by which intestinal inflammation magnified by gut-residing actors stimulates bone loss remains to be elucidated. In this article, we discuss the main risk factors potentially contributing to intestinal disease-associated bone loss, and summarize current animal models, illustrating gut-bone axis to bridge the gap between intestinal inflammation and skeletal disease.
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33
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Kearney N, Harnett C, Keohane J, Thorne J, Feighery C, Collins S. Acute penoscrotal and soft tissue swelling with cutaneous plaques. Int J Dermatol 2019; 59:371-372. [PMID: 31724736 DOI: 10.1111/ijd.14710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/28/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Niamh Kearney
- Department of, Dermatology, Our Lady of Lourdes Hospital, Drogheda, Louth, Ireland
| | - Clare Harnett
- Department of, Dermatology, Our Lady of Lourdes Hospital, Drogheda, Louth, Ireland
| | - John Keohane
- Department of, Gastroenterology, Our Lady of Lourdes Hospital, Drogheda, Louth, Ireland
| | - Jane Thorne
- Department of, Pathology, Our Lady of Lourdes Hospital, Drogheda, Louth, Ireland
| | - Cliona Feighery
- Department of, Dermatology, Our Lady of Lourdes Hospital, Drogheda, Louth, Ireland
| | - Sinead Collins
- Department of, Dermatology, Our Lady of Lourdes Hospital, Drogheda, Louth, Ireland
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Ribaldone DG, Vernero M, Parisi S, Ditto MC, Pellicano R, Morino M, Saracco GM, Fusaro E, Astegiano M. Risk factors of suspected spondyloarthritis among inflammatory bowel disease patients. Scand J Gastroenterol 2019; 54:1233-1236. [PMID: 31549896 DOI: 10.1080/00365521.2019.1668052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Occurring in approximately 20-30% of patients, spondyloarthritis is the most common extraintestinal manifestation in inflammatory bowel disease (IBD).Aims: To look for risk factors of spondyloarthritis among inflammatory bowel disease patients.Methods: We modified the STRIPP questionnaire created for psoriatic patients and we created a rapid questionnaire for rheumatologic investigation in IBD patients (STRII). We submitted the questionnaire to all consecutive patients with a known spondyloarthritis in our centre and to patients with a negative rheumatological diagnosis to find the cut-off value. Finally, we prospectively submitted the STRII questionnaire to all consecutive IBD patients in our centre.Results: A cut-off ≥3 correlated with spondyloarthritis with an AUC = 0.91. The STRII questionnaire was submitted to 1147 IBD patients. Two hundred and forty-four out of 1147 (21.3%) collected a STRII score of ≥3. Female sex (p < .0001) and Crohn's disease (p = .023) were risk factors. Patients with a history of at least 1 immunosuppressant or biologic drug (p = .002 and p < .0001, respectively) had a higher rate of positivity to STRII questionnaire.Conclusion: Among IBD patients, females, Crohn's disease, those with a history of at least 1 immunosuppressive or biological therapy are at increased risk of spondyloarthritis.
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Affiliation(s)
| | - Marta Vernero
- First Department of Internal Medicine, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Simone Parisi
- S.C. Reumatologia, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Maria Chiara Ditto
- S.C. Reumatologia, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | | | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Enrico Fusaro
- S.C. Reumatologia, Città Della Salute e Della Scienza di Torino, Turin, Italy
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Use of Tofacitinib for the Treatment of Arthritis Associated With Ulcerative Colitis. ACG Case Rep J 2019; 6:e00226. [PMID: 31750389 PMCID: PMC6831149 DOI: 10.14309/crj.0000000000000226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/16/2019] [Indexed: 12/14/2022] Open
Abstract
Tofacitinib is a Janus kinase 1–3 inhibitor initially approved for the treatment of rheumatoid arthritis and now approved for the treatment of moderately to severely active ulcerative colitis (UC). We present the case of a patient with UC and seronegative inflammatory arthritis in whom arthritis progressed while on vedolizumab and was successfully treated with tofacitinib. This case provides insight into the use of tofacitinib for the treatment of UC and a concomitant extraintestinal manifestation of joint involvement.
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36
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Schüle S, Frey D, Biedermann L, Grueber MM, Zeitz J, Vavricka S, Möller B, Rogler G, Misselwitz B. [From Axial Spondyloarthritis to Osteoporosis - Spectrum of Skeletal Involvement in Inflammatory Bowel Diseases]. PRAXIS 2019; 108:799-806. [PMID: 31530124 DOI: 10.1024/1661-8157/a003301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
From Axial Spondyloarthritis to Osteoporosis - Spectrum of Skeletal Involvement in Inflammatory Bowel Diseases Abstract. Inflammatory bowel diseases (IBD) are frequently accompanied by non-inflammatory joint pain and inflammatory spondyloarthritides. Spondyloarthritides can restrict joint function and typically manifest with inflammatory back pain with nightly pain and morning stiffness that improves upon exercising. In other patients, small or large peripheral joints are predominantly involved. Treatment comprises pain medication including COX-II selective non-steroidal anti-inflammatory drugs (NSAID), since non-selective NSAID can aggravate IBD. For axial manifestations, physiotherapy and tumor necrosis factor (TNF) inhibitors are effective, while for peripheral manifestations steroid injections, sulfasalazine and TNF inhibitors are useful. Osteopenia and osteoporosis may result from inflammation, malabsorption and/or steroids. Long-lasting disease activity or steroid treatment should prompt osteoporosis screening. Adequate calcium and vitamin D intake must be ensured and treatment with bisphosphonates evaluated.
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Affiliation(s)
- Solvey Schüle
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich und Universität Zürich
| | - Diana Frey
- Klinik für Rheumatologie, Universitätsspital Zürich und Universität Zürich
| | - Luc Biedermann
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich und Universität Zürich
| | | | - Jonas Zeitz
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich und Universität Zürich
- GastroZentrum Hirslanden, Klinik Hirslanden, Zürich
| | | | - Burkhard Möller
- Universitätsklinik für Rheumatologie, Immunologie und Allergologie, Inselspital Bern
| | - Gerhard Rogler
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich und Universität Zürich
| | - Benjamin Misselwitz
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich und Universität Zürich
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37
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Wendling D, Guillot X, Prati C, Miceli-Richard C, Molto A, Lories R, Dougados M. Effect of Gut Involvement in Patients with High Probability of Early Spondyloarthritis: Data from the DESIR Cohort. J Rheumatol 2019; 47:349-353. [PMID: 31154418 DOI: 10.3899/jrheum.181326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Inflammatory bowel disease (IBD) is a well-known extraarticular feature of spondyloarthritis (SpA). The aims of this study were to evaluate factors associated with IBD and incidence over 5 years of followup in the DESIR cohort. METHODS DESIR is a prospective observational cohort of patients with recent-onset inflammatory back pain suggestive of axial SpA. All available variables in the database were compared between patients with and without IBD at baseline and 5 years, and occurrence over 5 years of followup, with uni- and then multivariable analysis. RESULTS At baseline, of 708 patients, 35 had IBD (prevalence 4.94%, CI 95% 3.3-6.5). IBD was associated (multivariable) with history of uveitis, levels of Dickkopf-1, and tumor necrosis factor, but not with phenotypic presentation (peripheral arthritis, enthesitis, dactylitis, uveitis) or baseline serum levels of other cytokines. At 5 years, 480 patients were analyzed, 58 with IBD. IBD was associated (multivariable) with fulfillment of modified New York criteria, sick leave, Bath Ankylosing Spondylitis Disease Activity Index, and smoking. There was no association with magnetic resonance imaging scores, enthesitis, psoriasis, and bone mineral density. Twenty-three incident cases of IBD were recorded: estimated occurrence rate of 0.95/100 (95% CI 0.57-1.35) patient-years (PY). Incidence of IBD is associated (multivariable) with HLA-B27 (OR 0.36, 95% CI 0.22-0.59), fulfillment of modified New York criteria (OR 3.35, 95% CI 1.85-6.08), and familial history of IBD (OR 3.31, 95% CI 1.62-6.77). CONCLUSION In early SpA, IBD occurs with an incidence of 1/100 PY, and is associated with poor outcome, familial history of IBD, absence of HLA-B27, and fulfillment of modified New York criteria.
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Affiliation(s)
- Daniel Wendling
- From Rheumatology, CHRU de Besançon (University Teaching Hospital); Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE, Besançon; Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, European League Against Rheumatism (EULAR) Center Of Excellence; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France; Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium. .,D. Wendling, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); X. Guillot, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Prati, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Miceli-Richard, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence; A. Molto, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; R. Lories, MD, PhD, Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven; M. Dougados, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité.
| | - Xavier Guillot
- From Rheumatology, CHRU de Besançon (University Teaching Hospital); Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE, Besançon; Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, European League Against Rheumatism (EULAR) Center Of Excellence; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France; Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium.,D. Wendling, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); X. Guillot, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Prati, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Miceli-Richard, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence; A. Molto, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; R. Lories, MD, PhD, Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven; M. Dougados, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité
| | - Clément Prati
- From Rheumatology, CHRU de Besançon (University Teaching Hospital); Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE, Besançon; Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, European League Against Rheumatism (EULAR) Center Of Excellence; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France; Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium.,D. Wendling, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); X. Guillot, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Prati, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Miceli-Richard, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence; A. Molto, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; R. Lories, MD, PhD, Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven; M. Dougados, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité
| | - Corinne Miceli-Richard
- From Rheumatology, CHRU de Besançon (University Teaching Hospital); Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE, Besançon; Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, European League Against Rheumatism (EULAR) Center Of Excellence; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France; Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium.,D. Wendling, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); X. Guillot, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Prati, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Miceli-Richard, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence; A. Molto, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; R. Lories, MD, PhD, Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven; M. Dougados, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité
| | - Anna Molto
- From Rheumatology, CHRU de Besançon (University Teaching Hospital); Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE, Besançon; Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, European League Against Rheumatism (EULAR) Center Of Excellence; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France; Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium.,D. Wendling, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); X. Guillot, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Prati, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Miceli-Richard, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence; A. Molto, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; R. Lories, MD, PhD, Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven; M. Dougados, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité
| | - Rik Lories
- From Rheumatology, CHRU de Besançon (University Teaching Hospital); Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE, Besançon; Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, European League Against Rheumatism (EULAR) Center Of Excellence; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France; Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium.,D. Wendling, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); X. Guillot, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Prati, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Miceli-Richard, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence; A. Molto, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; R. Lories, MD, PhD, Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven; M. Dougados, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité
| | - Maxime Dougados
- From Rheumatology, CHRU de Besançon (University Teaching Hospital); Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE, Besançon; Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, European League Against Rheumatism (EULAR) Center Of Excellence; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France; Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium.,D. Wendling, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4266 (Pathogens and Inflammation, EPILAB); X. Guillot, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Prati, MD, PhD, Rheumatology, CHRU de Besançon (University Teaching Hospital), and Université Bourgogne Franche-Comté, EA4267 (PEPITE), FHU INCREASE; C. Miceli-Richard, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence; A. Molto, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; R. Lories, MD, PhD, Division of Rheumatology, Department of Development and Regeneration, University Hospital Leuven, KU Leuven; M. Dougados, MD, PhD, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, AP-HP, EULAR Center Of Excellence, and INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité
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Fragoulis GE, Liava C, Daoussis D, Akriviadis E, Garyfallos A, Dimitroulas T. Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment. World J Gastroenterol 2019; 25:2162-2176. [PMID: 31143068 PMCID: PMC6526158 DOI: 10.3748/wjg.v25.i18.2162] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/11/2019] [Accepted: 04/19/2019] [Indexed: 02/06/2023] Open
Abstract
Spondyloarthropathies (SpA) include many different forms of inflammatory arthritis and can affect the spine (axial SpA) and/or peripheral joints (peripheral SpA) with Ankylosing spondylitis (AS) being the prototype of the former. Extra-articular manifestations, like uveitis, psoriasis and inflammatory bowel disease (IBD) are frequently observed in the setting of SpA and are, in fact, part of the SpA classification criteria. Bowel involvement seems to be the most common of these manifestations. Clinically evident IBD is observed in 6%-14% of AS patients, which is significantly more frequent compared to the general population. Besides, it seems that silent microscopic gut inflammation, is evident in around 60% in AS patients. Interestingly, occurrence of IBD has been associated with AS disease activity. For peripheral SpA, two different forms have been proposed with diverse characteristics. Of note, SpA (axial or peripheral) is more commonly observed in Crohn's disease than in ulcerative colitis. The common pathogenetic mechanisms that explain the link between IBD and SpA are still ill-defined. The role of dysregulated microbiome along with migration of T lymphocytes and other cells from gut to the joint ("gut-joint" axis) has been recognized, in the context of a genetic background including associations with alleles inside or outside the human leukocyte antigen system. Various therapeutic modalities are available with monoclonal antibodies against tumour necrosis factor, interleukin-23 and interleukin-17, being the most effective. Both gastroenterologists and rheumatologists should be alert to identify the co-existence of these conditions and ideally follow-up these patients in combined clinics.
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Affiliation(s)
- George E Fragoulis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, “Laiko” General Hospital, Athens 11527, Greece
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow G128TA, United Kingdom
| | - Christina Liava
- 4th Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Dimitrios Daoussis
- Department of Internal Medicine, Division of Rheumatology, Patras University Hospital, Patras 26504, Greece
| | - Euangelos Akriviadis
- 4th Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Alexandros Garyfallos
- 4th Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Theodoros Dimitroulas
- 4th Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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Kelly OB, Li N, Smith M, Chan J, Inman RD, Silverberg MS. The Prevalence and Clinical Associations of Subclinical Sacroiliitis in Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1066-1071. [PMID: 30428061 DOI: 10.1093/ibd/izy339] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sacroiliitis, an inflammatory arthropathy associated with ankylosing spondylitis (AS), is found in patients with inflammatory bowel disease (IBD) but may go undiagnosed. The aims of this study were to assess prevalence of sacroiliitis in IBD and to determine association between clinical characteristics of IBD and sacroiliitis. METHODS Inflammatory bowel disease patients undergoing abdomino-pelvic computed tomography (CT) for any indication (2006-2015) were identified. Using standardized CT scoring, sacroiliitis was confirmed. Two blinded readers used a standardised model where presence of ankylosis or erosion score >3 indicated sacroiliitis. Inflammatory bowel disease scoring was blinded to the presence of sacroiliitis. Demographics, IBD characteristics, clinical activity (Harvey Bradshaw Index >4, Mayo >2, as denoted by attending physician), endoscopic activity (Simple Endoscopic Score for Crohn's Disease >4/Mayo subscore >1), and arthritis/extraintestinal manifestations (EIMS) were recorded. Comparisons were made between those with/without sacroiliitis. RESULTS Three hundred sixteen patients were included (50% male; 74% Crohn's disease [CD]). Computed tomography scoring identified 49 (16%) with sacroiliitis. Radiologists had reported sacroiliitis in 33% of these. Five patients had been to a spondylitis clinic. Thirty-three of 49 had abdominal x-rays; 64% of these fulfilled the imaging component of Modified New York criteria for AS. More than 5 sacroiliac erosions were associated with radiologist-reported sacroiliitis (P < 0.0001). There was no difference in prevalence between CD and ulcerative colitis. Sacroiliitis was associated with male sex (63.3% vs 47.9%; odds ratio [OR], 1.8; P = 0.04), known arthritis (41% vs 12%; OR, 4.7; P < 0.0001), pain as an IBD symptom (77.7% vs 56.9%; P = 0.03), and CD inflammatory phenotype (P = 0.01). Endoscopic activity, location, and extent were not associated. CONCLUSIONS Sacroiliitis is underdiagnosed in IBD and is associated with male sex, arthritis, and inflammatory CD. Data support targeted screening in at-risk patients.
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Affiliation(s)
- Orlaith B Kelly
- Zane Cohen Center for Digestive Disease, Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Nicole Li
- Zane Cohen Center for Digestive Disease, Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Michelle Smith
- Zane Cohen Center for Digestive Disease, Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Jonathan Chan
- Arthritis Centre of Excellence, Division of Rheumatology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert D Inman
- Arthritis Centre of Excellence, Division of Rheumatology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mark S Silverberg
- Zane Cohen Center for Digestive Disease, Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Hiller A, Biedermann L, Fournier N, Butter M, Vavricka SR, Ciurea A, Rogler G, Scharl M. The appearance of joint manifestations in the Swiss inflammatory bowel disease cohort. PLoS One 2019; 14:e0211554. [PMID: 31039159 PMCID: PMC6490952 DOI: 10.1371/journal.pone.0211554] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 01/16/2019] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Extraintestinal manifestations (EIM) involving joints, skin, eyes and liver represent an important problem in the treatment of IBD patients. The aim of this study was to identify factors that are associated with the occurrence of joint EIM and therefore allow an early diagnosis and guide medical treatment. Methods We studied clinical and epidemiological data from 3298 patients included in the Swiss IBD Cohort Study (SIBDCS), 1860 suffered from Crohn’s disease (CD) and 1438 from ulcerative colitis or IBD unclassified (UC/IBDU). Results We found female gender as well as a longer disease duration and activity (specified as CDAI or MTWAI, respectively) to be related to the appearance of arthritis/arthralgia, but also sacroiliitis/ankylosing spondylitis in IBD patients. IBD patients with arthritis/arthralgia or sacroiliitis/ankylosing spondylitis were more often treated with anti-TNF and patients with arthritis/arthralgia underwent more often IBD-related surgeries. We revealed that eye or skin EIM were more frequent in patients with arthritis/arthralgia or sacroiliitis/ankylosing spondylitis. In multivariate analysis, we confirmed female gender, longer disease duration, IBD-related surgery, presence of other EIM and treatment with anti-TNF to be independent risk factors for the onset of arthritis/arthralgia in CD and UC/IBDU patients. Conclusion In this study, we demonstrated that markers for a more severe disease course were associated with the onset of joint EIM in IBD patients. Our data suggest that in particular females under anti-TNF treatment and patients suffering from non-joint and/or IBD-related surgery should be close and carefully monitored for presence of arthritis or sacroiliitis/ankylosing spondylitis.
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Affiliation(s)
- Aimee Hiller
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolas Fournier
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Butter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephan R. Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- * E-mail:
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Ribaldone DG, Pellicano R, Actis GC. The gut and the inflammatory bowel diseases inside-out: extra-intestinal manifestations. MINERVA GASTROENTERO 2019; 65:309-318. [PMID: 30994321 DOI: 10.23736/s1121-421x.19.02577-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An increasing deal of attention is being conveyed on the extra-intestinal manifestations (EIM) of inflammatory bowel diseases (IBD). We compiled the present review in an attempt to upgrade the accuracy of the classification of such polymorphic entities. We focused on three patterns. First, the conventional EIM localized to bone and joints, to the eye, to the biliary tree and to the skin. Second, the so-called IBD-like syndromes accompanied by bone marrow-derived anomalies of innate or acquired immunity. Third, specific disorders of the skin and of the lungs. EIM are thought to derive from an altered gut permeability, the release of cross-reacting antigens, and subsequent peripheral inflammation; T helper 17 cells boosted by a polymorphic interleukin 23 circuitry would be the main effectors of this chain. Inflammatory bowel disease-like pictures would derive from inborn errors of the immune response causing undue inflammation home to the gut. Monogenic IBD belong to this subset, and are of specific pediatric interest. Psoriasis, chronic obstructive pulmonary disease, and IBD are all inflammatory disorders of the barrier organs: skin, lungs, and gut. The demonstration that specific antigen hyper- or hyporesponsiveness raised at any of the three districts can modulate the response of the other two sites, has led to the innovative concept of a system-wide mucosal immunological organ. An improved knowledge of these entities has not only a speculative importance, but can also bear a clinical impact, insofar as EIM prove often more disabling than the underlying IBD itself.
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Affiliation(s)
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette-S. Giovanni Antica Sede Hospital, Turin, Italy
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Ziade N, Abi Karam G, Merheb G, Mallak I, Irani L, Alam E, Messaykeh J, Menassa J, Mroue' K, Uthman I, Masri AF, Ghorra P, Witte T, Baraliakos X. HLA-B27 prevalence in axial spondyloarthritis patients and in blood donors in a Lebanese population: Results from a nationwide study. Int J Rheum Dis 2019; 22:708-714. [PMID: 30729696 DOI: 10.1111/1756-185x.13487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 12/31/2022]
Abstract
AIM To calculate the prevalence of human leukocyte antigen (HLA)-B27 in axial spondyloarthritis patients (axSpA) compared to blood donors (BD) in Lebanon, to identify the clinical and radiological findings associated with HLA-B27 and to estimate the proportion of patients fulfilling the clinical arm of the Assessment of the Spondyloarthritis International Association (ASAS) criteria. METHOD Consecutive Lebanese adult axSpA patients fulfilling the ASAS classification criteria were included from 12 rheumatology clinics across Lebanon. BD served as controls. A binary logistic regression was used to study the association between HLA-B27 and the disease features. RESULTS A total of 247 individuals were included (141 axSpA patients and 106 BD). The prevalence of HLA-B27 was 3.8% in BD and 41.1% in axSpA. Overall, 39.7% of the axSpA patients fulfilled the clinical arm of the ASAS classification criteria. Sensitivity of HLA-B27 for axSpA was 41.1%, specificity was 96.2%, positive predictive value was 93.6%, and negative predictive value was 55.13%. Positive likelihood ratio (LR) was 10.9 and negative LR was 1.63. We found a positive association of HLA-B27 with family history of SpA and psoriasis. CONCLUSION Our study confirmed a low prevalence of HLA-B27 in axSpA patients and BD in this Lebanese population, However, we found a high specificity and positive LR, as well as the same number of axSpA patients fulfilling the clinical arm of the ASAS criteria as in European studies. HLA-B27 is therefore valuable for identification of axSpA in Lebanese patients despite the overall low prevalence in this population. Our results may guide future evaluations the role of HLA-B27 in planning local referral strategies.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Ghada Abi Karam
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Georges Merheb
- Rheumatology Department, Holy Spirit University, Kaslik, Lebanon.,Rheumatology Department, Notre-Dame des Secours University, Lebanon
| | - Iyad Mallak
- Radiology Department, Hotel-Dieu de France, Beirut, Lebanon
| | - Laure Irani
- Lebanese University Hospital, Beirut, Lebanon.,Rizk University Medical Center, Beirut, Lebanon
| | - Elie Alam
- Levant Hospital, Sin-el-Fil, Lebanon
| | | | - Jeanine Menassa
- Lebanese University Hospital, Beirut, Lebanon.,Geitawi Hospital, Beirut, Lebanon
| | | | - Imad Uthman
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Pierre Ghorra
- Blood Transfusion Center, Hotel-Dieu de France, Beirut, Lebanon
| | | | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr-Universität Bochum, Bochum, Germany
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Schreiber S, Colombel JF, Feagan BG, Reich K, Deodhar AA, McInnes IB, Porter B, Das Gupta A, Pricop L, Fox T. Incidence rates of inflammatory bowel disease in patients with psoriasis, psoriatic arthritis and ankylosing spondylitis treated with secukinumab: a retrospective analysis of pooled data from 21 clinical trials. Ann Rheum Dis 2019; 78:473-479. [PMID: 30674475 PMCID: PMC6530077 DOI: 10.1136/annrheumdis-2018-214273] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 12/14/2022]
Abstract
Objectives Here, we present the reported incidence rates of inflammatory bowel disease (IBD) in patients receiving treatment with secukinumab for psoriasis (PsO), psoriatic arthritis (PsA) or ankylosing spondylitis (AS), in a pooled analysis of 21 clinical trials. Methods Data from all patients who had received at least one dose of secukinumab were included. Safety analyses were conducted to evaluate cumulative IBD rates as well as per-year rates, by indication. Crohn’s disease (CD), ulcerative colitis (UC) and IBD unclassified (IBDU) events were analysed using exposure-adjusted incidence rates (patient incidence rates per 100 patient-years (PY)). Results A total of 7355 patients with a cumulative exposure of 16 226.9 PY were included in the pooled analysis. Among 5181 patients with PsO, there were 14 cases of UC, 5 cases of CD and 1 case of IBDU, with exposure adjusted incidence rates (EAIRs) of 0.13, 0.05 and 0.01, respectively. Of these 20 cases, 14 were new-onset. In 1380 patients with PsA, there were 3 cases of UC, 3 cases of CD and 2 cases of IBDU (EAIRs 0.08, 0.08 and 0.05); 7 of these represented new-onset cases. Among 794 patients with AS, there were 4 cases of UC, 8 cases of CD and 1 case of IBDU (EAIRs 0.2, 0.4 and 0.1); 9 were new-onset cases. In the per year analysis, the EAIRs for each indication did not increase over time with secukinumab treatment. Conclusions In this pooled secukinumab safety analysis of 7355 patients across 21 clinical trials, cases of IBD events (including CD, UC and IBDU) were uncommon.
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Affiliation(s)
- Stefan Schreiber
- University Hospital Schleswig Holstein, Christian-Alrechts-University, Kiel, Germany
| | | | - Brian G Feagan
- Robarts Clinical Trials, Western University, London, Ontario, Canada
| | - Kristian Reich
- Dermatologikum Berlin and SCIderm Research Institute, Hamburg, Germany
| | - Atul A Deodhar
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Ayan Das Gupta
- Novartis Healthcare Pvt. Ltd, Hyderabad, Telangana, India
| | - Luminita Pricop
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Todd Fox
- Novartis Pharma AG, Basel, Switzerland
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Abstract
Inflammatory bowel disease (IBD) is a systemic, chronic autoimmune disease of the digestive tract. The etiology and pathophysiology of IBD is not fully understood, though it is believed to be due to a complex interaction among the patient's genotype, immune system, and environmental factors. Inflammatory bowel disease is frequently accompanied by extraintestinal manifestations that occur in almost half of all patients. The most common extraintestinal manifestation that occurs is joint disease, collectively termed the arthropathies of IBD. While epidemiological studies have estimated that the arthropathies of IBD occur in over 46% of the IBD population, there is a paucity of nursing literature concerning the extraintestinal manifestations of IBD and the role of nurses in patient care. Thus, the purpose of this article is to facilitate a greater understanding for nurses and nurse clinicians regarding the arthropathies associated with IBD including classifications, pathophysiology, diagnosis, and management.
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Cai T, Lin TC, Bond A, Huang J, Kane-Wanger G, Cagan A, Murphy SN, Ananthakrishnan AN, Liao KP. The Association Between Arthralgia and Vedolizumab Using Natural Language Processing. Inflamm Bowel Dis 2018; 24:2242-2246. [PMID: 29846617 PMCID: PMC6140445 DOI: 10.1093/ibd/izy127] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The gut-selective nature of vedolizumab has raised questions regarding increased joint pain or arthralgia with its use in inflammatory bowel disease (IBD) patients. As arthralgias are seldom coded and thus difficult to study, few studies have examined the comparative risk of arthralgia between vedolizumab and tumor necrosis factor inhibitor (TNFi). Our objectives were to evaluate the application of natural language processing (NLP) to identify arthralgia in the clinical notes and to compare the risk of arthralgia between vedolizumab and TNFi in IBD. METHODS We performed a retrospective study using a validated electronic medical record (EMR)-based IBD cohort from 2 large tertiary care centers. The index date was the first date of vedolizumab or TNFi prescription. Baseline covariates were assessed 1 year before the index date; patients were followed 1 year after the index date. The primary outcome was arthralgia, defined using NLP. Using inverse probability of treatment weight to balance the cohorts, we then constructed Cox regression models to calculate the hazard ratio (HR) for arthralgia in the vedolizumab and TNFi groups. RESULTS We studied 367 IBD patients on vedolizumab and 1218 IBD patients on TNFi. Patients on vedolizumab were older (mean age, 41.2 vs 34.9 years) and had more prevalent use of immunomodulators (52.3% vs 31.9%) than TNFi users. Our data did not observe a significantly increased risk of arthralgia in the vedolizumab group compared with TNFi (HR, 1.20; 95% confidence interval, 0.97-1.49). CONCLUSIONS In this large observational study, we did not find a significantly increased risk of arthralgia associated with vedolizumab use compared with TNFi.
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Affiliation(s)
- Tianrun Cai
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tzu-Chieh Lin
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Allison Bond
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jie Huang
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Gwendolyn Kane-Wanger
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Andrew Cagan
- Research Computing, Partners HealthCare, Charlestown, Massachusetts
| | - Shawn N Murphy
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts,Research Computing, Partners HealthCare, Charlestown, Massachusetts
| | | | - Katherine P Liao
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts,Address correspondence to: Katherine P. Liao, MD, MPH, Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115 ()
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Dubash S, Marianayagam T, Tinazzi I, Al-Araimi T, Pagnoux C, Weizman AV, Richette P, Tran Minh ML, Allez M, Singh A, Ciccia F, Hamlin J, Tan AL, Marzo-Ortega H, McGonagle D. Emergence of severe spondyloarthropathy-related entheseal pathology following successful vedolizumab therapy for inflammatory bowel disease. Rheumatology (Oxford) 2018; 58:963-968. [DOI: 10.1093/rheumatology/key267] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/19/2018] [Indexed: 01/15/2023] Open
Affiliation(s)
- Sayam Dubash
- Department of Rheumatology, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Ilaria Tinazzi
- Division of General Medicine, Rheumatology Unit, Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | - Tariq Al-Araimi
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Christian Pagnoux
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Adam V Weizman
- Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Canada
| | - Pascal Richette
- Lariboisiere Hospital, Rheumatology Department, APHP, University of Paris, Diderot, France
| | - My-Linh Tran Minh
- Department of Gastroenterology, APHP, Saint Louis Hospital, Paris Diderot, Sorbonne Paris-Cité University, Paris, France
| | - Matthieu Allez
- Department of Gastroenterology, APHP, Saint Louis Hospital, Paris Diderot, Sorbonne Paris-Cité University, Paris, France
| | - Animesh Singh
- Department of Rheumatology, Royal Free Hospital, London, UK
| | - Francesco Ciccia
- Dipartimento Biomedico di Medicina Interna e Specialistica, Sezione di Reumatologia, Università degli studi di Palermo, Palermo, Italy
| | - John Hamlin
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ai Lyn Tan
- Department of Rheumatology, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Helena Marzo-Ortega
- Department of Rheumatology, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Dennis McGonagle
- Department of Rheumatology, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Lim CSE, Sengupta R, Gaffney K. The clinical utility of human leucocyte antigen B27 in axial spondyloarthritis. Rheumatology (Oxford) 2018; 57:959-968. [PMID: 29029331 DOI: 10.1093/rheumatology/kex345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Indexed: 12/17/2022] Open
Abstract
The association between HLA-B27 and AS was first established in the early 1970s. Since then, our understanding of this disease has changed, such that we now recognize AS to be the extreme of the clinical phenotype within a disease spectrum known as axial SpA (axSpA). Recent advances in therapeutic options have driven the need for earlier diagnosis and many screening strategies have been proposed to facilitate this. In parallel, our understanding of axSpA genetics, and especially the contribution of HLA-B27, has expanded. In this article we will present and discuss the evidence supporting the use of HLA-B27 in clinical practice. We will briefly summarize the evolution of the concept of axSpA, the prevalence of HLA-B27 and axSpA and the potential role of HLA-B27 in the aetiopathogenesis of axSpA and focus on the utility of HLA-B27 in everyday clinical practice.
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Affiliation(s)
| | - Raj Sengupta
- Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Karl Gaffney
- Rheumatology Department, Norfolk & Norwich University Hospital, Norwich, UK
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Hammoudeh M, Elsayed E, Al-Kaabi S, Sharma M, Elbadri M, Chandra P, Abu Nahia N, Hammoudeh S. Rheumatic manifestations of inflammatory bowel diseases: A study from the Middle East. J Int Med Res 2018; 46:3837-3847. [PMID: 29961404 PMCID: PMC6136032 DOI: 10.1177/0300060518781404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To examine the prevalence of rheumatic manifestations among patients with
inflammatory bowel disease (IBD). Methods This prospective study enrolled patients with IBD in whom the diagnosis and
extent of IBD were confirmed by colonoscopy and histopathology. Patients
were interviewed and examined by a rheumatologist. A complete
rheumatological examination, X-rays of the lumbosacral and sacroiliac joints
and HLA-B27 blood tests were performed. Results A total of 127 adult patients were recruited: 46 (36.2%) with Crohn’s disease
(CD) and 81 (63.8%) with ulcerative colitis (UC). Rheumatic manifestations
of any type were present in 57.5% (73 of 127 patients) with no significant
differences between CD and UC. Peripheral manifestations were present in
43.3% (55 of 127 patients), four patients (3.1%) had axial arthritis alone
and 14 patients (11.0%) had both types. Among those with peripheral
manifestations, five patients (7.2%) had type 1 arthritis (pauciarticular)
and one patient (1.4%) had type 2 arthritis (polyarticular). A higher
proportion of patients with CD had axial manifestations with or without
peripheral manifestations (eight of 46; 17.4%) compared with patients with
UC (10 of 81; 12.3%), but no difference was observed in patients with
peripheral manifestations alone. Conclusions Rheumatic manifestations in patients with IBD in Qatar are more prevalent
than in other regions of the world. Peripheral manifestations were more
prevalent than axial.
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Affiliation(s)
- Mohammed Hammoudeh
- 1 Department of Medicine, Rheumatology Section, Hamad Medical Corporation, Doha, Qatar
| | - Eman Elsayed
- 1 Department of Medicine, Rheumatology Section, Hamad Medical Corporation, Doha, Qatar
| | - Saad Al-Kaabi
- 2 Department of Medicine, Gastroenterology Section, Hamad Medical Corporation, Doha, Qatar
| | - Manik Sharma
- 2 Department of Medicine, Gastroenterology Section, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Elbadri
- 2 Department of Medicine, Gastroenterology Section, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- 3 Medical Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Niveen Abu Nahia
- 2 Department of Medicine, Gastroenterology Section, Hamad Medical Corporation, Doha, Qatar
| | - Samer Hammoudeh
- 4 Research Department, Weill Cornell Medicine-Qatar, Doha, Qatar
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Claudepierre P, Fagnani F, Cukierman G, de Chalus T, Joubert JM, Laurendeau C, Gourmelen J, Breban M. Burden of severe spondyloarthritis in France: A nationwide assessment of prevalence, associated comorbidities and cost. Joint Bone Spine 2018; 86:69-75. [PMID: 29709699 DOI: 10.1016/j.jbspin.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/13/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To estimate the number of patients with severe spondyloarthritis (SpA) in France, describe their comorbidities and document and value their healthcare resource consumption. METHODS Data were retrieved from an insurance claims database covering a 1/97 random sample of the French population. All patients benefiting from full insurance coverage ("ALD") for severe SpA in 2012 (including cases with structural damage and/or frequent flares) were identified, together with a control group frequency-matched by age and gender. Severe comorbidities were documented through ALD categories. Healthcare resource consumption was documented and valued from the payer's perspective. Rates of comorbidities and costs were compared in SpA patients versus controls using non-parametric testing. RESULTS Overall, 827 patients with ALD status for severe SpA were identified (control group: n=2.481), corresponding to a prevalence rate of 0.18% [0.17-0.19] for SpA with ALD in the general population. Severe comorbidities more frequent in patients with SpA than in controls included inflammatory bowel disorders (odds ratio: 15.0 [6.2-36.2]), hypertension (2.5 [1.6-3.9]), atrial fibrillation (4.3 [1.9-9.6]) and major depressive disorder (2.1 [1.3-3.6]). Mean per capita annual direct healthcare expenditure was 3.6 [3.2-4.1]-fold higher in SpA patients (€6,122 [€5,838-€6,406]) than in controls (€1,682 [€1,566-€1,798]). Extrapolating to all patients in France, total healthcare cost attributable to severe SpA patients was €391 [€355-€426] million, with medication accounting for 53.8% of this cost. CONCLUSIONS The burden of severe SpA in France is substantial, due to the high prevalence, high direct costs and associated comorbidities.
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Affiliation(s)
- Pascal Claudepierre
- Rheumatology department, université Paris Est Créteil, Henri-Mondor Hospital, EA 7379, EpidermE, AP-HP, 94010 Créteil, France.
| | | | | | | | | | | | | | - Maxime Breban
- Rheumatology department, Ambroise-Paré hospital, AP-HP, 92100 Boulogne, France; UMR 1173 Inserm, university of Versailles-Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France; Laboratoire d'Excellence Inflamex, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
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50
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Alivernini S, Pugliese D, Tolusso B, Bui L, Petricca L, Guidi L, Mirone L, Rapaccini GL, Federico F, Ferraccioli G, Armuzzi A, Gremese E. Paradoxical arthritis occurring during anti-TNF in patients with inflammatory bowel disease: histological and immunological features of a complex synovitis. RMD Open 2018; 4:e000667. [PMID: 29657833 PMCID: PMC5892785 DOI: 10.1136/rmdopen-2018-000667] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/03/2018] [Accepted: 03/08/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Paradoxical arthritis under tumour necrosis factor inhibitor (TNF-i) for inflammatory bowel disease (IBD) has been described. This study aims to evaluate the histological features of paired synovial tissue (ST) and colonic mucosa (CM) tissue in patients with IBD developing paradoxical arthritis under TNF-i. METHODS Patients with IBD without history of coexisting joint involvement who developed arthritis under TNF-i were enrolled. Each patient underwent ST biopsy and ileocolonoscopy with CM biopsies. ST and CM paired samples were stained through immunohistochemistry (IHC) for CD68, CD21, CD20, CD3 and CD117. Clinical and immunological parameters (anticitrullinated peptides antibodies (ACPA)-immunoglobulin (Ig)M/IgA rheumatoid factor (RF)) were collected. Psoriatic arthritis (PsA) and ACPA/IgM-RF/IgA-RF negative rheumatoid arthritis (RA) were enrolled as comparison. RESULTS 10 patients with IBD (age 46.0±9.7 years, 13.2±9.9 years of disease duration, 2.5±1.6 years of TNF-i exposure, six with Crohn's disease and four with ulcerative colitis, respectively) were studied. At ST level, IHC revealed that patients with IBD with paradoxical arthritis showed more similar histological findings in terms of synovial CD68+, CD21+, CD20+, CD3+ and CD117+ cells compared with PsA than ACPA/IgM-RF/IgA-RF negative RA. Analysing the CM specimens, patients with IBD showed the presence of CD68+, CD3+, CD117+ and CD20+ cells in 100%, 70%, 60% and 50% of cases, respectively, despite endoscopic remission. Finally, addition of conventional disease-modifying antirheumatic drugs and switch to ustekinumab were more effective than swapping into different TNF-i in patients with IBD with paradoxical arthritis. CONCLUSION Patients with IBD may develop histologically proven synovitis during TNF-i, comparable to PsA. The inhibition of inflammatory pathways alternative to TNF (IL12/1L23) may be an effective therapeutic option for severe paradoxical articular manifestations.
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Affiliation(s)
- Stefano Alivernini
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniela Pugliese
- IBD Unit, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Laura Bui
- Institute of Pathology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Luisa Guidi
- IBD Unit, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Luisa Mirone
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Gian Ludovico Rapaccini
- IBD Unit, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Federico
- Institute of Pathology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Gianfranco Ferraccioli
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Armuzzi
- IBD Unit, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
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