Increased Risk of Inflammatory Bowel Disease Among Patients With Ankylosing Spondylitis: A 13-Year Population-Based Cohort Study

Abstract

Aim Ankylosing spondylitis (AS) primarily affects the axial skeleton and extraarticular structures. Small-scaled studies have reported that the incidence and prevalence of inflammatory bowel disease (IBD) are higher in patients with AS than in the general population. This study determined the incidence of IBD in patients with AS using a large scale population-based cohort dataset. Methods This was a retrospective cohort study. Patient data were collected from the Taiwan National Health Insurance Research Database from 2000 to 2012. We enrolled 3,804 patients with AS and 7,608 non-AS patients. The endpoint was IBD diagnosis by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding 555 and 556 after at least three outpatient visits or one hospital admission, until the end of 2012. The Kaplan–Meier analysis was performed to discriminate the cumulative incidence of IBD and the log-rank test was used to test the significance. A Cox proportional hazard model was used to estimate the hazard ratio (HR) for IBD between the AS and non-AS groups. Results Among the population as a whole the Cox proportional hazard regression indicated that patients aged ≥65 years [adjusted HR (aHR): 2.48, 95% confidence interval (CI): 1.38–4.47] or with comorbidity of cancer (aHR: 3.51, 95% CI: 1.40–8.80) had a higher HR for IBD. Kaplan–Meier curves of cumulative incidence proportion of IBD indicated that patients with AS had a higher risk of IBD than the non-AS group in the subgroup aged <40 years (HR: 2.85, 95% CI: 1.51–5.40, p = 0.001). Conclusions Patients with AS aged <40 years had a higher IBD risk than did those without AS in Taiwan. Clinicians and patients should be aware of this association.

Circular RNAs in peripheral blood mononuclear cells from ankylosing spondylitis

“…A study from the United States reviewed the status of solid cancer in elderly patients with AS from 1999 to 2010 and found that the risk of esophageal cancer, gastric cancer, and lung cancer was lower and the risk of melanoma, urinary system cancer, and breast cancer was higher [24] . Two other studies have similar findings [25,26] . Combined with the enrichment results of this study, there may be similar pathways but different feedback mechanisms between AS and different tumors, especially colon cancer, gastric cancer, and other gastrointestinal cancers.…”

“…[ 24 ] Two other studies have similar findings. [ 25 , 26 ] Combined with the enrichment results of this study, there may be similar pathways but different feedback mechanisms between AS and different tumors, especially colon cancer, gastric cancer, and other gastrointestinal cancers. This may have important implications for the treatment and prognosis of the disease.…”

Spectrum of Spondyloarthritis Among Chinese Populations

“…Based on Taiwan National Health Insurance Research Database (NHIRD) from 2005 to 2012, the overall incidence of IBD was lower in the AS group than in the non-AS group, but without reaching statistical significance (1.41 vs. 1.79 per 1000 person-years, incidence rate 0.79, 95% CI 0.48–1.28; p = 0.332) [ 113 ]. Interestingly, another retrospective cohort study based on the same database from 2000 to 2012 showed that patients with AS had a higher risk of IBD than the non-AS group in the subgroup aged < 40 years (HR: 2.85, 95% CI: 1.51–5.40) [ 114 ].…”

Long-Term Adherence to Etanercept in Treatment Effectiveness of Patients with Spondyloarthritis: 7-Year Data from the Iraq National Registry

“…Typically, the sacroiliac joints are also affected [9], and occasionally other joints such as the shoulders or hips are involved [10]. Eye and bowel problems may also occur [11,12]. Inflammatory low back pain that is intermittent in nature is a characteristic symptom of AS [9].…”