Risk of a subsequent diagnosis of inflammatory bowel disease in subjects with ophthalmic disorders associated with inflammatory bowel disease: a retrospective cohort analysis of UK primary care data

• Published in: BMJ open Vol. 12; no. 5; p. e052833
• Main Authors: King, Dominic, Chandan, Joht Singh, Thomas, Tom, Denniston, Alastair K, Braithwaite, Tasanee, Niranthrankumar, Krishnarajah, Reulen, Raoul, Adderley, Nicola, Trudgill, Nigel J
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 11.05.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Anemia; Arthritis; Body mass index; Child, Preschool; Cohort analysis; Cohort Studies; Colitis, Ulcerative - complications; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - epidemiology; Crohn Disease - complications; Crohn Disease - diagnosis; Crohn Disease - epidemiology; Crohn's disease; epidemiology; Female; gastroenterology; Gastroenterology and Hepatology; Humans; Immunosuppressive agents; Inflammation; Inflammation - complications; Inflammatory bowel disease; Inflammatory Bowel Diseases - complications; Inflammatory Bowel Diseases - diagnosis; Inflammatory Bowel Diseases - epidemiology; Male; Medical diagnosis; Medical practices; Middle Aged; Missing data; ophthalmology; Primary care; Primary Health Care; Retrospective Studies; Risk Factors; Steroids; Tumor necrosis factor-TNF; United Kingdom - epidemiology; United Kingdom; United Kingdom > UK; epidemiology; ophthalmology; gastroenterology; inflammatory bowel disease
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-052833

ObjectivesOphthalmic conditions including anterior uveitis (AU), episcleritis and scleritis may occur in association with the inflammatory bowel diseases (IBD) as ophthalmic extraintestinal manifestations. The aim of this study was to assess the risk of a later IBD diagnosis in those presenting with IBD associated ocular inflammation (IAOI).DesignRetrospective cohort study.SettingPrimary care UK database.Participants38 805 subjects with an IAOI were identified (median age 51 (38–65), 57% women) and matched to 153 018 subjects without IAOI.MeasuresThe risk of a subsequent diagnosis of IBD in subjects with IAOIs compared with age/sex matched subjects without IAOI. HRs were adjusted for age, sex, body mass index, deprivation, comorbidity, smoking, baseline axial arthropathy, diarrhoea, loperamide prescription, anaemia, lower gastrointestinal bleeding and abdominal pain.Logistic regression was used to produce a prediction model for a diagnosis of IBD within 3 years of an AU diagnosis.Results213 (0.6%) subsequent IBD diagnoses (102 ulcerative colitis (UC) and 111 Crohn’s disease (CD)) were recorded in those with IAOIs and 329 (0.2%) (215 UC and 114 CD) in those without. Median time to IBD diagnosis was 882 (IQR 365–2043) days in those with IAOI and 1403 (IQR 623–2516) in those without. The adjusted HR for a subsequent diagnosis of IBD was 2.25 (95% CI 1.89 to 2.68), p<0.001; for UC 1.65 (95% CI 1.30 to 2.09), p<0.001; and for CD 3.37 (95% CI 2.59 to 4.40), p<0.001 in subjects with IAOI compared with those without.Within 3 years of an AU diagnosis, 84 (0.5%) subjects had a recorded diagnosis of IBD. The prediction model performed well with a C-statistic of 0.75 (95% CI 0.69 to 0.80).ConclusionsSubjects with IAOI have a twofold increased risk of a subsequent IBD diagnosis. Healthcare professionals should be alert for potential signs and symptoms of IBD in those presenting with ophthalmic conditions associated with IBD.