Monday, 20 May 2019

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An Association between GCA and IBD ?

A population based analysis from Israel suggests that giant cell arteritis (GCA) patients may be at increased risk for  inflammatory bowel diseases (IBD) mainly target.

This research was based on sporadic reports in the medical literature (http://bit.ly/2pnIPM0)

Claims data analysis of 3938 GCA patients and 21,623 matched controls finds that  GCA patients had a significantly increased rates of CD and UC (0.79% vs. 0.12% and 0.84% vs. 0.21%, P-value < .001, respectively) when compared to normal controls.

This GCA and IBD association was negatively correlated with the patients' age; and was more robust in middle-aged (OR = 8.13) than in elderly patients (OR = 3.81).

Such data should influence the medical and GI evaluations of GCA patients suffering from gastrointestinal complaints, especially in middle-aged patients (50-69 years of age).  Moreover, age related routine colonoscopy should be strongly encouraged in such GCA patients.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

The GI literature is growing with the suggestion that IL-6 is the next cytokine in Crohn's Disease. The question I have had to come to terms with is when it is seen in younger patients < 40 yo) and whether this is Takayasu's or Aortitis unique to CD. As such is this an extra-intestinal manifestation that might parallel the bowel (e.g. Type I Peripheral arthritis) or march on independent of the bowel (e.g spondylitis).
IL-6 is a potential new target but there is really very little published data on IL-6 inhibition in IBD patients. Whether large vessels vasculitis could be considered an extraintestinal manifestation is interesting but best left to an IBD expert to address - Ill see if I can get one to address this for you, me and the RheumNow audience. Thanks for these thoughtful comments. JC

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