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P285 Extraintestinal manifestations of Crohn’s disease have a major influence on anxiety levels and coping skills

D. Schwartz*1, E. Chernin2, D. Greenberg2, O. Sarid2, V. Slonim-Nevo2, M. Friger2, H. Vardi2, S. Odes2

1Soroka UMC, Gastroenterology, Beer Sheva, Israel, 2Ben Gurion University, Beer Sheva, Israel

Background

Crohn’s disease (CD) is a chronic disease influencing both physical and social aspects of life. Extraintestinal manifestations (EIM) including arthropathy, eye inflammation, and skin inflammation are commonly associated with CD, and their direct influence on anxiety and coping skills may be substantial. We assessed these psychosocial aspects in Israeli patients with Crohn’s disease.

Methods

Israeli CD patients were asked to fill a questionnaire containing clinical data, including disease severity by the Harvey–Bradshaw Index (HBI), symptoms of extraintestinal manifestations, and psychological data, including the Brief Symptom Inventory (BSI) and BRIEF COPE Inventory.

Results

Of the available 488 patients, 215 (44%) reported having symptoms of arthritis or arthralgia; 93 (19.3%) eye inflammation; 51 (10.6%) skin inflammation; and 35 (7.3%) deep skin ulcers. Of the patients with reported EIM, 61.3% had 1 EIM; 25% had 2 EIM; 9.2% had 3 EIM; and 4.5% had 4 EIM. Females had more EIM (56% vs 45.1%, p = 0.019). Patients who reported symptoms of EIM had a higher HBI score (8.13 ± 5.8 vs 3.8 ± 3.9, p < 0.001) were more likely to report a poor economic state (25.7% vs 12.1% p < 0.001) and to be unemployed (37.6% vs 28% p = 0.024) compared with patients without EIM. The presence of EIM was associated with higher anxiety levels (Figure 1).

Figure 1. BSI in patients with and without EIM symptoms.

and reduced coping skills. Patients who reported arthritis or arthralgia had an increase of all BSI scales. Coping ability was affected in self-distraction, denial, religion, and self-blame. Patients who reported ocular symptoms had an increase of all BSI scales. Coping ability was affected only by religion. Patients reporting skin inflammation had an increase in all the BSI scales except for depression, paranoid ideation, and positive symptom distress index. Coping ability was only significant for denial. Patients reporting big deep skin ulcers had an increase in the BSI scale, including somatisation, global severity index, and positive symptom total. Coping ability was only significant for denial. In a multivariable regression analysis, the global severity index of the BSI scale was associated with HBI, smoking, and EIM (Table 1).

Table 1 Multivariable quintile regression analysis of GSI adjusted to demographics (only statistical)

GSI25%50%75%90%
GenderNSNSNSNS
Age-0.002NS-0.011-0.011
HBI0.0280.0520.0740.085
Disease durationNSNSNSNS
SmokingNS0.219NSNS
EIMNS0.138NSNS

Conclusion

Extraintestinal manifestations in Crohn’s disease have detrimental effect on anxiety levels and coping skills. Treating physicians should offer support to these patients.