IgA vasculitis in patients with inflammatory bowel disease: new insights into the role of TNF-α blockers.

Autor:	Rasmussen C; Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)., Abitbol V; Department of Gastroenterology, Hopital Cochin, APHP-CUP, Paris., El Karoui K; Department of Nephrology, Hôpital Henri Mondor, AP-HP, Créteil., Bourrier A; Department of Gastroenterology, Hôpital Saint-Antoine, AP-HP, Paris., Paule R; Department of Internal Medicine, Hôpital Foch, Suresnes., Vuitton L; Department of Gastroenterology, CHRU, Besançon., Maurier F; Department of Internal Medicine GH UNEOS, Metz., Laharie D; Department of Gastroenterology, CHU, Bordeaux., Fuméry M; Department of Gastroenterology, CHU, Amiens., Agard C; Department of Internal Medicine, CHU Nantes, Nantes., Collins M; Department of Gastroenterology, Hopital Bicêtre, AP-HP, Le Kremlin-Bicêtre., Nancey S; Department of Gastroenterology, CHU, Lyon., Rafat C; Department of Nephrology, Hôpital Tenon, AP-HP, Paris., Kervegant AG; Department of Internal Medicine, CHBA, Vannes., Queyrel-Moranne V; Department of Internal Medicine, CHU, Nice., Moulis G; Department of Internal Medicine, CHU Purpan, Toulouse., Pigneur B; Pediatric Gastroenterology, Hepatology and Nutrition, Hôpital Necker, AP-HP.; Université de Paris, Paris., Régent A; Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP).; Université de Paris, Paris., Gay C; Department of Gastroenterology, CHRU, Besançon., Morbieu C; Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP).; Université de Paris, Paris., Durel CA; Department of Internal Medicine, Hopital Edouard Herriot, Hospices Civils de Lyon, Lyon., Ducloux D; Department of Nephrology., Aubin F; Department of Dermatology., Voicu M; Department of Internal Medicine, CHRU Besançon, Besançon., Joher N; Department of Nephrology, Hôpital Henri Mondor, AP-HP, Créteil., Szwebel T; Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)., Martinez-Vinson C; Department of Pediatrics, Hôpital Robert Debré, AP-HP, Paris., Koch S; Department of Gastroenterology, CHRU, Besançon., Guillevin L; Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP).; Université de Paris, Paris., Peyrin-Biroulet L; Department of Gastroenterology, CHRU, Nancy, France., Terrier B; Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP).; Université de Paris, Paris.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2022 May 05; Vol. 61 (5), pp. 1957-1965.
DOI:	10.1093/rheumatology/keab662
Abstrakt:	Objective: The association of IgA vasculitis (IgAV) and IBD is rarely described, mainly during anti-TNF-α therapy. We aimed to describe the association of IgAV and IBD. Methods: We retrospectively analysed the association of IgAV and IBD through the implication of the GETAID and FVSG networks. Characteristics of IBD and IgAV were collected using a standardized case report form. Results: Forty-three cases were included. IBD [mainly Crohn's disease (CD) in 58%] preceded IgAV in 38 (88%), with median interval of 9.2 (IQR 5.4-15.4) years. In these 38 patients, at IgAV diagnosis, five (13%) had active IBD and 28 (74%) were treated with anti-TNF-α for a median duration of 31.5 (IQR 19-56) months. Main IgAV manifestations were purpura all patients (100%), joints in 20/35 (57%), renal in 15/35 (43%) and gastrointestinal in 11/35 (31%) involvement. IgAV was treated with glucocorticoids in 25 (66%), colchicine in six (16%), CYC in six (16%) and anti-TNF-α were discontinued in 15/28 (54%). No IgAV relapse occurred when TNF-α blockers were stopped, vs 23% in patients pursuing it. Conversely, five (33%) had IBD flare or complication after anti-TNF-α cessation vs one (8%) in those continuing biologics. Anti-TNF-α were resumed in six (40%), with subsequent IgAV relapse in four (67%). Conclusions: This large cohort suggests that TNF-α blockers may promote the onset of IgAV in IBD. Discontinuation of anti-TNF-α was associated with vasculitis remission but increased risk of IBD relapses, whereas continuation of anti-TNF-α was associated with IBD remission but vasculitis relapse. (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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