Early Arthritis Is Associated With Failure of Immunosuppressive Drugs and Severe Pediatric Crohn's Disease Evolution
| Autor: | Mohamed Damir, Ulrich Meinzer, Naim Ouldali, Christine Martinez-Vinson, Jérôme Viala, Jean-Pierre Hugot |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Population Arthritis Severity of Illness Index 03 medical and health sciences 0302 clinical medicine Crohn Disease Interquartile range Internal medicine Severity of illness medicine Immunology and Allergy Humans 030212 general & internal medicine Prospective Studies Treatment Failure Prospective cohort study education Child Retrospective Studies education.field_of_study business.industry Gastroenterology Retrospective cohort study medicine.disease 030211 gastroenterology & hepatology Electronic data Female business Immunosuppressive Agents Cohort study Follow-Up Studies |
| Zdroj: | Inflammatory bowel diseases. 24(11) |
| ISSN: | 1536-4844 |
| Popis: | Background Crohn's disease (CD) is a chronic relapsing inflammatory disease. To optimize therapeutic decision making, it is essential to identify parameters that allow early prediction of a severe disease course. The aim of this study was to assess the link between arthritis and medium-term therapeutic failure in pediatric CD. Methods We conducted a population-based cohort study with prospectively collected electronic data. To be included, patients must be younger than 17 years and have a confirmed CD diagnosed between 2005 and 2014. The primary outcome was the percentage of patients with at least 1 therapeutic failure of immunosuppressive drugs during the 2 years after the CD diagnosis, with a propensity score analysis. Results We included 272 patients with CD. The median age was 12.1 years (interquartile [10.1-14.2]). Sixty-five patients (23.9%) developed arthritis, which predominantly occurred during the first year after CD diagnosis. We found a highly significant association between arthritis and therapeutic failure of immunosuppressive drugs after 2 years (OR = 6.9; 95% confidence interval [CI], 2.7-18.0; P < 0.0001; propensity score matching analysis). Arthritis was also significantly associated with introduction of biotherapy due to luminal disease 2 years after diagnosis (OR = 3.2, 95% CI, 1.8-6.0; P = 0.0001). Similar results were obtained after 4 years, and arthritis was significantly associated with a higher number of hospitalizations for luminal flare-up or complications after 4 years (OR = 2.2; 95% CI, 1.2-3.9; P = 0.007). Conclusions Arthritis was strongly associated with medium-term therapeutic failure of pediatric CD. Occurrence of arthritis early in the disease may justify closer follow-up visits or specific therapeutic management. |
| Databáze: | OpenAIRE |
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