Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature

Alice Sy; Nader Khalidi; Natasha Dehghan; Lillian Barra; Simon Carette; David Cuthbertson; Gary S Hoffman; Curry L Koening; Carol A Langford; Carol McAlear; Larry Moreland; Paul A Monach; Philip Seo; Ulrich Specks; Antoine Sreih; Steven R Ytterberg; Gert Van Assche; Peter A Merkel; Christian Pagnoux; Vasculitis Clinical Research Consortium (VCRC); Canadian Vasculitis Network (CanVasc)

doi:10.1016/j.semarthrit.2015.07.006

Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature

Semin Arthritis Rheum. 2016 Feb;45(4):475-82. doi: 10.1016/j.semarthrit.2015.07.006. Epub 2015 Jul 26.

Authors

Alice Sy¹, Nader Khalidi², Natasha Dehghan³, Lillian Barra⁴, Simon Carette¹, David Cuthbertson⁵, Gary S Hoffman⁶, Curry L Koening⁷, Carol A Langford⁶, Carol McAlear⁸, Larry Moreland⁹, Paul A Monach¹⁰, Philip Seo¹¹, Ulrich Specks¹², Antoine Sreih⁸, Steven R Ytterberg¹³, Gert Van Assche¹⁴, Peter A Merkel⁸, Christian Pagnoux¹⁵; Vasculitis Clinical Research Consortium (VCRC); Canadian Vasculitis Network (CanVasc)

Affiliations

¹ Division of Rheumatology, Mount Sinai Hospital, University of Toronto, The Joseph and Wolf Lebovic Building, 60 Murray St, Ste 2-220, Toronto, Ontario, Canada M5T 3L9.
² Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada.
³ Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada.
⁵ Department of Biostatistics, University of South Florida, Tampa, FL.
⁶ Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH.
⁷ Division of Rheumatology, University of Utah, Salt Lake City, UT.
⁸ Division of Rheumatology, University of Pennsylvania, Philadelphia, PA.
⁹ Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA.
¹⁰ The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, MA; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA.
¹¹ Division of Rheumatology, Johns Hopkins University, Baltimore, MD.
¹² Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN.
¹³ Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN.
¹⁴ Division of Gastroenterology, University of Toronto-Inflammatory Bowel Disease Clinic, Toronto, Ontario, Canada.
¹⁵ Division of Rheumatology, Mount Sinai Hospital, University of Toronto, The Joseph and Wolf Lebovic Building, 60 Murray St, Ste 2-220, Toronto, Ontario, Canada M5T 3L9. Electronic address: cpagnoux@msn.com.

Abstract

Background: Published small case series suggest that inflammatory bowel disease [IBD; Crohn's disease (CD) or ulcerative colitis (UC)] and vasculitis co-occur more frequently than would be expected by chance.

Objectives: To describe this association by an analysis of a large cohort of carefully studied patients and through a systematic literature review.

Methods: Patients with both IBD and vasculitis enrolled in the Vasculitis Clinical Research Consortium (VCRC) Longitudinal Studies, followed in Canadian Vasculitis research network (CanVasc) centers and/or in the University of Toronto's IBD clinic were included in this case series. A systematic literature review of patients with IBD and vasculitis involved a PubMed search through February 2014. The main characteristics of patients with Takayasu arteritis (TAK) and IBD were compared to those in patients with TAK without IBD followed in the VCRC.

Results: The study identified 32 patients with IBD and vasculitis: 13 with large-vessel vasculitis [LVV; 12 with TAK, 1 with giant cell arteritis (GCA); 8 with CD, 5 with UC]; 8 with ANCA-associated vasculitis [AAV; 6 granulomatosis with polyangiitis (GPA), 2 with eosinophilic granulomatosis with polyangiitis (EGPA)]; 5 with isolated cutaneous vasculitis; and 6 with other vasculitides. Patients with LVV and AAV were mostly female (18/21). The diagnosis of IBD preceded that of vasculitis in 12/13 patients with LVV and 8/8 patients with AAV. The review of the literature identified 306 patients with IBD and vasculitis: 144 with LVV (133 TAK; 87 with IBD preceding LVV), 19 with AAV [14 GPA, 1 EGPA, 4 microscopic polyangiitis (MPA)], 66 with isolated cutaneous vasculitis, and 77 with other vasculitides. Patients with IBD and TAK were younger and had more frequent headaches, constitutional symptoms, or gastrointestinal symptoms compared to those patients in the VCRC who had TAK without IBD.

Conclusions: These findings highlight the risk of vasculitis, especially TAK, in patients with IBD (both CD and UC).

Keywords: Crohn’s disease; Inflammatory bowel disease; Takayasu arteritis; Ulcerative colitis; Vasculitis.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Female
Humans
Inflammatory Bowel Diseases / complications*
Male
Retrospective Studies
Vasculitis / complications*

Abstract

Publication types

MeSH terms

Grants and funding