Spinal epidural abscess (SEA) is an uncommon but serious condition with significant morbidity and mortality. The prognosis of SEA is highly dependent on the timeliness of its diagnosis before neurological deficits develop. Unfortunately, often due to its nonspecific presentation, such as back pain, the diagnosis of SEA may be delayed in up to 75% of cases. Although many risk factors for SEA can be found in the published literature, their utility is limited by their frequent lack of objective evidence, numerousness, and absence in a significant proportion of cases. In this review, we call for a more discriminate evidence-based use of the term “risk factor” when discussing SEA and explore several approaches to its earlier diagnosis, including a simple algorithm based on its pathophysiology and serum C-reactive protein or erythrocyte sedimentation rate.

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Background: The gut-selective nature of vedolizumab has raised questions regarding increased joint pain or arthralgias with its use in IBD patients. Since arthralgias are seldom coded and thus difficult to study, few studies have examined the comparative risk of arthralgias between vedolizumab and tumor necrosis factor inhibitor (TNFi). Objectives: To evaluate the application of natural language processing (NLP) to identify arthralgias in the clinical notes, and to compare the risk of arthralgia between vedolizumab and TNFi in IBD. Methods: We performed a retrospective study using a validated electronic medical record (EMR) based IBD cohort from 2 large tertiary care centers. The index date was the first date of vedolizumab or TNFi prescription. Baseline covariates were assessed 1-year period before the index date; patients were followed 1-year after the index date. The primary outcome was arthralgias defined using NLP. Using inverse probability of treatment weight to balance the cohorts, we then constructed Cox regression models to calculate the hazard ratio (HR) for arthralgia in the vedolizumab vs TNFi groups. Results: We studied 367 patients on vedolizumab and 1,218 on TNFi IBD patients. Patients on vedolizumab were older, mean age 41.2 vs. 34.9 years, and had more prevalent use of immunomodulators, 52.3% vs. 31.9%, than TNFi users. Our data did not observe a significant increased risk of arthralgias in the vedolizumab group compared with TNFi (HR, 1.20; 95%CI, 0.97–1.49). Conclusions: In this large observational study, we did not find a significant increased risk of arthralgias associated with vedolizumab use compared with TNFi.

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