Sébastien Humbert1, Philippe Guilpain2, Xavier Puéchal3, Benjamin Terrier3, Sophie Rivière1, Alfred Mahr4, Christian Pagnoux3, Denis Bagnères5, Jean-François Cordier6, Alain Le Quellec1, Romain Altwegg7, Loïc Guillevin3. 1. Service de Médecine Interne, Université Montpellier 1, Maladies Multi-organiques, centre de compétence des maladies systémiques et auto-immunes rares de l'adulte, Hôpital Saint-Eloi, CHRU de Montpellier, Montpellier. 2. Service de Médecine Interne, Université Montpellier 1, Maladies Multi-organiques, centre de compétence des maladies systémiques et auto-immunes rares de l'adulte, Hôpital Saint-Eloi, CHRU de Montpellier, Montpellier, p-guilpain@chu-montpellier.fr. 3. Faculté de Médecine, Université Paris Descartes, Pôle de Médecine Interne et Centre National de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Hôpital Cochin, APHP, Paris. 4. Service de Médecine Interne, Hôpital Saint-Louis, Université Paris 7, APHP, Paris. 5. Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Marseille. 6. Service de Pneumologie, Centre de Référence des Maladies Orphelines Pulmonaires, Hôpital Louis Pradel, Université Lyon I, Hospices Civils de Lyon, Lyon and. 7. Département d'Hépato-Gastroentérologie, Hôpital Saint-Eloi, Université Montpellier 1, CHRU de Montpellier, Montpellier, France.
Abstract
OBJECTIVE: Coexistence of ANCA-associated vasculitis (AAV) and IBD is a rare condition that is rarely described in the literature. The aim of the study was to describe the main characteristics of patients presenting with both IBD and AAV. METHODS: A retrospective study of AAV patients in the French Vasculitis Study Group cohort who also had a diagnosis of IBD was conducted. We reviewed the medical records and outcomes of these patients. RESULTS: We identified 11 patients with AAV and IBD. Four patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss) also had ulcerative colitis and seven patients with granulomatosis with polyangiitis (GPA) had Crohn's disease. No Crohn's disease was observed in eosinophilic GPA and no ulcerative colitis in GPA. IBD started before AAV manifestations in six cases, simultaneously in two cases and after AAV manifestations in three cases. CONCLUSION: Coexistence of IBD and AAV is a rare condition. The therapeutic management of these patients includes corticosteroids in all cases and immunosuppressive drugs in some patients. Coexistence of IBD and AAV might be explained by common underlying inflammatory responses and cytokine profiles polarized towards either Th1 or Th2. Finally, in the presence of digestive manifestations in the context of AAV, the hypothesis of IBD should be assessed.
OBJECTIVE: Coexistence of ANCA-associated vasculitis (AAV) and IBD is a rare condition that is rarely described in the literature. The aim of the study was to describe the main characteristics of patients presenting with both IBD and AAV. METHODS: A retrospective study of AAV patients in the French Vasculitis Study Group cohort who also had a diagnosis of IBD was conducted. We reviewed the medical records and outcomes of these patients. RESULTS: We identified 11 patients with AAV and IBD. Four patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss) also had ulcerative colitis and seven patients with granulomatosis with polyangiitis (GPA) had Crohn's disease. No Crohn's disease was observed in eosinophilic GPA and no ulcerative colitis in GPA. IBD started before AAV manifestations in six cases, simultaneously in two cases and after AAV manifestations in three cases. CONCLUSION: Coexistence of IBD and AAV is a rare condition. The therapeutic management of these patients includes corticosteroids in all cases and immunosuppressive drugs in some patients. Coexistence of IBD and AAV might be explained by common underlying inflammatory responses and cytokine profiles polarized towards either Th1 or Th2. Finally, in the presence of digestive manifestations in the context of AAV, the hypothesis of IBD should be assessed.
Authors: Alice Sy; Nader Khalidi; Natasha Dehghan; Lillian Barra; Simon Carette; David Cuthbertson; Gary S Hoffman; Curry L Koening; Carol A Langford; Carol McAlear; Larry Moreland; Paul A Monach; Philip Seo; Ulrich Specks; Antoine Sreih; Steven R Ytterberg; Gert Van Assche; Peter A Merkel; Christian Pagnoux Journal: Semin Arthritis Rheum Date: 2015-07-26 Impact factor: 5.532