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Background In a 6-year, multicenter, prospective nested case–control study, we aimed to evaluate risk factors for incident cancer in inflammatory bowel disease (IBD), when considering clinical characteristics of IBD and immunomodulator use. The secondary end point was to provide characterization of incident cancer types. Methods All incident cases of cancer occurring in IBD patients from December 2011–2017 were prospectively recorded in 16 Italian Group for the Study of Inflammatory Bowel Disease units. Each of the IBD patients with a new diagnosis of cancer was matched with 2 IBD patients without cancer, according to IBD phenotype (ulcerative colitis [UC] vs Crohn’s disease [CD]), age (±5 years), sex. Risk factors were assessed by multivariate logistic regression analysis. Results Cancer occurred in 403 IBD patients: 204 CD (CD cases), 199 UC (UC cases). The study population included 1209 patients (403 IBD cases, 806 IBD controls). Cancer (n = 403) more frequently involved the digestive system (DS; 32%), followed by skin (14.9%), urinary tract (9.7%), lung (6.9%), genital tract (6.5%), breast (5.5%), thyroid (1.9%), lymphoma (2.7%, only in CD), adenocarcinoma of the small bowel (SBA; 3.9%, 15 CD, 1 pouch in UC), other cancers (15.9%). Among cancers of the DS, colorectal cancer (CRC) more frequently occurred in UC (29% vs 17%; P < 0.005), whereas SBA more frequently occurred in CD (13% vs 6.3% P = 0.039). In CD, perforating (B3) vs non-stricturing non-perforating (B1) behavior represented the only risk factor for any cancer (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.33–4.11). In CD, risk factors for extracolonic cancer (ECC) were a B3 vs B1 and a stricturing (B2) vs B1 behavior (OR, 2.95; 95% CI, 1.62–5.43; OR, 1.79; 95% CI, 1.09–2.98). In UC, risk factors for ECC and for overall cancer were abdominal surgery for UC (OR, 4.63; 95% CI, 2.62–8.42; OR, 3.34; 95% CI, 1.88–5.92) and extensive vs distal UC (OR, 1.73; 95% CI, 1.10–2.75; OR, 1.99; 95% CI, 1.16–3.47). Another risk factor for ECC was left-sided vs distal UC (OR, 1.68; 95% CI, 1.00–2.86). Inflammatory bowel disease duration was a risk factor for skin and urinary tract cancers. Conclusions Perforating CD, extensive UC, and abdominal surgery for UC were identified as risk factors for overall incident cancer and for ECC. The clinical characteristics associated with severe IBD may increase cancer risk.

In a multicentre study, penetrating CD and extensive UC were risk factors for cancer overall. Cancer incidence was higher in CD than in UC.

These findings suggest the existence of a positive feedback mechanism involving cytokines and ADAM19 that can amplify cytokine production in IBD.

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BackgroundEnteropathic spondyloarthritis (eSpA) is a chronic autoimmune disease associated with inflammatory bowel disease (IBD) that is poorly diagnosed and managed.ObjectivesTo assess the diagnostic and therapeutic effect of a combined gastro-rheumatological approach in eSpA patients.MethodsIBD-patients with joint pain referred to a dedicated rheumatologist by gastroenterologist were enrolled. Clinical and biochemical variables, SpA and intestinal disease activity measures, and treatment (biologic; bDMARDs and conventional synthetic; csDMARDs) were recorded at baseline, 3, 6, 12 and 24 months. The association between treatment on demographic and clinical characteristics was evaluated by logistic regression.ResultsFrom a total of 229 IBD patients, 147 (64.2%) were diagnosed with eSpA; 96 (65.3%) showing peripheral involvement and 51 (34.7%) with axial involvement. The majority (67.3%) of eSpA patients were female (n=99), median age and disease duration of 46 and 14.6 years. bDMARD treatment increased over the follow-up period (baseline-24 months: 32.6%>60%; AOR:3.45, 95% CI: 1.93–6.2, p<0.001), however, their use was less frequent in elderly patients (AOR: 0.73, 95% CI: 0.56–0.96, p=0.023), in ulcerative colitis patients (AOR:0.43, 95% CI:0.2–0.94, p=0.034) and in patients with peripheral involvement (AOR:0.53, 95% CI:0.3–1.04, p=0.067). csDMARD use was increased in patients with peripheral involvement (AOR: 4.65, 95% CI:2.09–10.33, p<0.001) and in patient with ulcerative colitis (AOR:2.30, 95% CI:1.13–4.67, p=0.021) (figure 1). CRP, ESR, ASDAS-ESR levels and BASFI were significantly decreased over the follow-up period whereas pMayo score, BASDAI and HAQ-S were unchanged (figure 2).ConclusionsA multidisciplinary approach can improve in the therapeutic management and outcome (e.g. disease activity measures) of eSpA patients. bDMARD use paralleled an improvement in disease measures and confirmed a good safety profile.Disclosure of InterestNone declared

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