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* = Presenting author

P652 Treatment, evolution and associated risk factors of extraintestinal manifestations in patients with inflammatory bowel disease

M. Syed, A. Algaba*, I. Guerra, M. de Lucas, D. Bonillo, M. Hernández, A. Granja, F. Berrmejo

Hospital Universitario de Fuenlabrada, Gastroenterology, Madrid, Spain

Background

Patients with inflammatory bowel disease (IBD) present affectation in other organs different from digestive system that may cause great morbidity. Although, many extraintestinal (EIMs) are directly related to intestinal activity, other have independent course and need specific treatments. Our aims were to evaluate the characteristics, treatments and evolution of EIMs in patients with IBD in our environment and to identify the risk factors associated to them

Methods

Restrospective, observational, case-control study. All patients with Crohn's disease (CD) and ulcerative colitis (UC) and EIMs were considered as case. On the other hand, patients with IBD without EIMs were controls

Results

619 patients with IBD (327 CD, 265 UC, 27 indeterminate colitis) were included; mean age 45 ± 14 ys, 60% females, 24% smokers. 16.5% of patients showed at least one EMIs (n=102).The EIMs observed were: 40% of EIMs (n=50) musculoskeletal manifestations (26 arthritis, 13 ankylosing spondylitis, 9 sacroiliitis, 2 psoriatic arthritis), 40%(n=50) cutaneous manifestations (28 erythema nodosum, 14 aphthous stomatitis, 6 pyoderma gangrenosum, 1 Sweet's syndrome, 1 granulomatous dermatitis), 11.2%(n=14) ocular manifestations (7 uveitis and 7 episcleritis), 6.4%(n=8) vascular thrombosis and 2.4%(n=3) hepatobiliary disorders (2 primary sclerosing cholangitis and 1 autoimmune hepatitis).Arthropathies were treated with nonsteroidal anti-inflammatory drugs in 26% of cases, oral or intra-articular corticosteroids in 18%, methotrexate in 10%, anti-TNF drugs in 10% and salazopyrin in 8%. The treatment of cutaneous manifestations was mainly with corticosteroid (74%) and anti-TNF drugs (2%). Ocular manifestations were treated with topic corticosteroids in the 64.3% of patients and anti-TNF drugs in 7%. Globally, the efficacy of treatment used to treat EIMs was of 90% and only 13% of patients had recurrence of EIMs. The multivariate analysis showed that female gender was a significant risk factor to developed EIMs (p=0.012; OR=1.61; 95CI% 1.11-2.34). Also, the severity of IBD was associated with the development of EIMs, patients with severe IBD who needed immunosuppressant therapies alone (p=0.009; OR=1.65; 95CI% 1.13-2.4) or in combination with adalimumab (p=0.029; OR=2.28; 95CI% 1.09-4.78) had an increased risk of developing EIMs

Conclusion

The most frequent EIMs in our environment are musculoskeletal and cutaneous manifestations. Patients with female gender and patients with more therapeutics requirements (immunosuppressant or anti-TNF drugs) and therefore with more severe disease, have higher risk of developing EIMs. Individualized treatment of EIMs is effective in most of patients. The risk of EIMs recurrence is low in our series