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• W2092190921 abstract "Background & Aims: We aimed to discern the relative risk for several chronic inflammatory conditions in patients with ulcerative colitis (UC) and Crohn’s disease. Methods: We used the population-based University of Manitoba IBD Database that includes longitudinal files on all patients from all health system contacts identified by International Classification of Diseases, 9th revision, Clinical Modification codes for visit diagnosis. From the provincial database we extracted a control cohort matching the IBD patients 10:1 by age, sex, and geography. We considered a potential comorbid disease to be present if the patient had 5 or more health system contacts for that diagnosis. The comorbid disease period prevalence was analyzed separately for patients with UC and Crohn’s disease and a prevalence ratio was calculated comparing the IBD populations with the matched cohort. Results: There were 8072 cases of IBD from 1984 to 2003, including UC (n = 3879) and Crohn’s disease (n = 4193). There was a mean of approximately 16 person-years of coverage for both patients and control patients. Both UC and Crohn’s disease patients had a significantly greater likelihood of having arthritis, asthma, bronchitis, psoriasis, and pericarditis than population controls. An increased risk for chronic renal disease and multiple sclerosis was noted in UC but not Crohn’s disease patients. The most common nonintestinal comorbidities identified were arthritis and asthma. Conclusions: The finding of asthma as the most common comorbidity increased in Crohn’s disease patients compared with the general population is novel. These may be diseases with common causes or complications of one disease that lead to the presentation with another. Studies such as this should encourage further research into the common triggers in the organ systems that lead to autoimmune diseases. Background & Aims: We aimed to discern the relative risk for several chronic inflammatory conditions in patients with ulcerative colitis (UC) and Crohn’s disease. Methods: We used the population-based University of Manitoba IBD Database that includes longitudinal files on all patients from all health system contacts identified by International Classification of Diseases, 9th revision, Clinical Modification codes for visit diagnosis. From the provincial database we extracted a control cohort matching the IBD patients 10:1 by age, sex, and geography. We considered a potential comorbid disease to be present if the patient had 5 or more health system contacts for that diagnosis. The comorbid disease period prevalence was analyzed separately for patients with UC and Crohn’s disease and a prevalence ratio was calculated comparing the IBD populations with the matched cohort. Results: There were 8072 cases of IBD from 1984 to 2003, including UC (n = 3879) and Crohn’s disease (n = 4193). There was a mean of approximately 16 person-years of coverage for both patients and control patients. Both UC and Crohn’s disease patients had a significantly greater likelihood of having arthritis, asthma, bronchitis, psoriasis, and pericarditis than population controls. An increased risk for chronic renal disease and multiple sclerosis was noted in UC but not Crohn’s disease patients. The most common nonintestinal comorbidities identified were arthritis and asthma. Conclusions: The finding of asthma as the most common comorbidity increased in Crohn’s disease patients compared with the general population is novel. These may be diseases with common causes or complications of one disease that lead to the presentation with another. Studies such as this should encourage further research into the common triggers in the organ systems that lead to autoimmune diseases. IBDs such as Crohn’s disease and ulcerative colitis (UC) are considered to be diseases of immune dysregulation, occurring in patients with the appropriate genetic predispositions. This paradigm is shared by a number of other immune-mediated diseases, some of which are categorized as autoimmune diseases,1Davidson A. Diamond B. Autoimmune disease.N Engl J Med. 2001; 345: 340-350Google Scholar under the presumption that the body’s immune system is reacting against self. Whether or not the body is reacting against self or foreign antigens, there has been a clinical impression that the diseases cluster together.1Davidson A. Diamond B. Autoimmune disease.N Engl J Med. 2001; 345: 340-350Google Scholar, 2Ginn L.R. Lin J.P. Plotz P.H. et al.Familial autoimmunity in pedigrees of idiopathic inflammatory myopathy patients suggests common genetic risk factors for many autoimmune diseases.Arthritis Rheum. 1998; 41: 400-405Google Scholar A genome scan study showed nonrandom clustering of susceptibility loci of autoimmune diseases supporting the clinical impression that these diseases may cluster in individual patients.3Becker K.G. Simon R.M. Bailey-Wilson J.E. et al.Clustering of non-major histocompatibility complex susceptibility candidate loci in human autoimmune diseases.Proc Natl Acad Sci U S A. 1998; 95: 9979-9984Google Scholar There are a number of immune-mediated diseases known to be increased in IBD. These are the classic extraintestinal manifestations that include arthritis, ankylosing spondylitis, erythema nodosum, pyoderma gangrenosum, iritis, uveitis and other inflammatory ocular disorders, and primary sclerosing cholangitis. In a previous study, we reported the first assessment of these conditions (except for arthritis) in a North American population–based study.4Bernstein C.N. Blanchard J.F. Rawsthorne P. Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease a population-based study.Am J Gastroenterol. 2001; 96: 1116-1122Google Scholar We reported higher rates for several of these conditions and that 6% of IBD patients concomitantly have 1 of these disorders and .3% have as many as 2 or more. By using similar methodology we have pursued a population-based study assessing for a number of other chronic inflammatory conditions in patients with IBD. We have created a matched control group of patients not affected with IBD to determine the relative risks for these conditions in IBD. The finding of an increased association of chronic inflammatory diseases with either form of IBD could suggest a common genetic predisposition, common causative triggers, or possibly the triggering of one inflammatory condition secondary to the treatment of a primary inflammatory condition. Data for this study were derived from the Manitoba Health administrative databases. Manitoba Health provides universal health insurance for Manitoba residents that includes coverage for physician and hospital services. Manitoba Health maintains computerized records that are based on the use of health care services by individuals in the province, including admissions to hospitals and physician visits. For each physician service the patient’s identification, the date of service, the diagnosis (3-digit, International Classification of Diseases, 9th revision, Clinical Modification [ICD-9-CM] code), and the service tariff code are entered into a physician-claims database. Similarly, after each hospitalization, Manitoba hospitals submit an abstract to Manitoba Health that includes the patient’s identification, the dates of admission and discharge, the attending physicians, and up to 16 ICD-9-CM diagnoses. These hospital separation records constitute the hospital file. The accuracy of these administrative health data has been shown for a number of medical conditions.5Roos L.L. Mustard C.A. Nicol J.P. Registries and administrative data organization and accuracy.Med Care. 1993; 31: 201-212Google Scholar Manitoba Health also maintains a population registry that contains dates of insurance coverage, family information, and address for Manitoba residents. Death reports from Manitoba Vital Statistics are reviewed routinely and are used to update the population registry. Since 1984, the Manitoba Health population registry has maintained a unique personal health identification number that is included with each physician claim record and each hospital separation record. We have used the Manitoba Health databases previously to create the University of Manitoba IBD database.6Bernstein C.N. Blanchard J.F. Rawsthorne P. Wajda A. The epidemiology of Crohn’s disease and ulcerative colitis in a central Canadian province a population-based study.Am J Epidemiol. 1999; 149: 916-924Google Scholar This database includes all persons with a physician claim or hospitalization for a diagnosis of Crohn’s disease (ICD-9-CM code 555.xx) or UC (ICD-9-CM code 556.xx) since 1984. To improve the accuracy of case definition, persons residing in the province for at least 2 years were designated as having IBD only if they had at least 5 separate physician claims and/or hospitalizations. Persons residing in the province for less than 2 years were included in the IBD cohort if they had at least 3 separate physician claims and/or records. The accuracy of this case definition is high (sensitivity and specificity, ≃90%) in comparison with both self-report and chart review.5Roos L.L. Mustard C.A. Nicol J.P. Registries and administrative data organization and accuracy.Med Care. 1993; 31: 201-212Google Scholar The specificity of 90% refers to the specificity among those with at least 1 physician or hospital claim for a diagnosis of Crohn’s disease or UC. Because the vast majority of the population of Manitoba (>1,000,000) have no claims for either IBD diagnosis, the specificity of our definition actually is much closer to 100% in the general population. Recently, this methodology has been reproduced in a population-based study in Manitoba creating a multiple sclerosis database. This study found that for patients within Manitoba having at least 5 health system contacts (or if a resident in the province for 2 years or less, having 3 health system contacts), the sensitivity was 93% and the specificity was 99% of truly having multiple sclerosis.7Elliott L.J. Yu N. Melanson M. Green C. Blanchard J. Application of a validated method using medical claims data to demonstrate very high prevalence and incidence of multiple sclerosis in a Canadian province.Am J Epidemiol. 2004; 159: S59Google Scholar We selected all patients within our IBD database from April 1, 1984, to March 31, 2003 (19 years of data accrual). The data included the following possible immune-mediated diseases that might have occurred before, concurrent with, or after any initial contacts for IBD: asthma, bronchitis, arthritis, thyroiditis, multiple sclerosis, neuropathy (including hereditary and idiopathic peripheral neuropathies), myasthenia gravis, chronic renal disease, psoriasis, and pericarditis (Table 1 lists the ICD-9-CM codes for these diseases). In assessing arthritis we included both degenerative and immune-mediated arthritis, recognizing the potential lack of precision with coding by physicians for arthritis. The classic arthritis associated with either UC or Crohn’s disease is neither considered to be osteoarthritis nor rheumatoid arthritis; hence it is unknown which arthritis code physicians would use most typically. We compared the period prevalence and prevalence ratios for osteoarthritis (ICD-9-CM code 715) with rheumatoid arthritis (ICD-9-CM 714).Table 1ICD-9-CM Codes for Diseases AssessedDiseaseICD-9-CM codesAsthma493.xxBronchitis491.xxArthritis715.xx, 714.xx, 446.xx, 710.xxThyroiditis245.xxMultiple sclerosis340.xxNeuropathy356.xxMyasthenia gravis358Chronic renal disease580.xx-583.xxPsoriasis691.xxPericarditis420.xx, 423.1 Open table in a new tab Assessing renal diseases using administrative data is not simple. ICD-9-CM codes 580.xx include glomerulonephritis of various types, but ICD-9-CM 580.89 includes glomerulonephritis with interstitial (diffuse or focal) nephritis. ICD-9-CM code 581.x is for other glomerulonephritides that cause nephrotic syndrome and code 581.89 is for nephrotic syndrome associated with interstitial nephritis. ICD-9-CM code 582.x is for chronic glomerulonephritis (including 582.89 for chronic glomerulonephritis with interstitial nephritis) and code 583.x is for a variety of nephritides. Although it would be of great interest to attempt to differentiate renal diseases such as glomerulonephritis from interstitial nephritis, it may be unreliable to attempt this by using administrative data that rely on physician coding. Between April 1, 1984, and March 31, 2003, there were 8072 patients who met the IBD case definition. Over time, 838 patients died and 756 patients moved out of the province. Manitoba Health lost track of 155 patients (these patients most likely moved out of the province as well). Table 2, Table 3 show a total of 8060 patients because 12 patients did not have matching controls. For Crohn’s disease patients there were 16.39 ± 4.8 (SD) person-years of coverage. For UC patients there were 16.62 ± 4.53 (SD) person-years of coverage. The number of patients with IBD in Manitoba on March 31, 2003, was 6321.Table 2Prevalence and PRs of Comorbid Diagnoses in UCSingle health contact≥ 5 health contactsControls n = 38,674UC cases n = 3873UC PR (95% CI)ControlsUC cases n = 3873UC PR (95% CI)Asthma15.08%21.17%1.53 (1.41–1.66)4.9%7.88%1.66 (1.46–1.88)Bronchitis4.34%5.65%1.33 (1.15–1.54).32%.67%2.10 (1.36–3.23)Arthritis24.8%30.9%1.47 (1.35–1.59)8.35%11.77%1.55 (1.39–1.74)Thyroiditis1.16%1.57%1.37 (1.04–1.80).15%.23%1.58 (.79–3.2)Multiple sclerosis.76%1.37%1.81 (1.35–2.42).29%.54%1.90 (1.19–3.03)Neuropathy1.4%2.40%1.75 (1.39–2.18).12%.18%1.47 (.66–3.25)Myasthenia gravis.18%.36%2.2 (1.26–3.85).04%.07%1.66 (.49–5.65)Chronic renal disease.86%1.52%1.78 (1.35–2.35).16%.39%2.46 (1.40–4.35)Psoriasis6.23%9.19%1.53 (1.36–1.71)1.04%1.7%1.65 (1.27–2.15)Pericarditis.55%2.09%1.46 (1.00–2.13).07%.23%3.33 (1.57–7.07) Open table in a new tab Table 3Prevalence and PRs for Comorbid Diagnoses in Crohn’s DiseaseSingle health contact≥5 health contactsControls n = 41,815CD cases n = 4187CD PR (95% CI)Controls n = 41,815CD cases n = 4187CD PR (95% CI)Asthma15.7%19.9%1.34 (1.24–1.46)5.1%7.09%1.43 (1.26–1.62)Bronchitis3.38%4.49%1.36 (1.16–1.59).26%.48%1.86 (1.15–3.02)Arthritis20.1%25.0%1.43 (1.31–1.55)6.32%7.88%1.24 (1.12–1.39)Thyroiditis1.29%1.46%1.13 (1.87–1.48).20%.19%.96 (.47–2.0)Multiple sclerosis.97%1.62%1.69 (1.31–2.19).37%.41%1.11 (.67–1.84)Neuropathy1.29%2.34%1.85 (1.48–2.30).13%.10%.74 (.27–2.05)Myasthenia gravis.15%.57%1.43 (.71–2.87)0.04%0Chronic renal disease.78%1.82%2.37 (1.85–3.06).20%.26%1.34 (.72–2.52)Psoriasis6.28%9.39%1.55 (1.39–1.73)1.07%1.7%1.59 (1.24–2.05)Pericarditis.45%.88%1.96 (1.38–2.78).06%.19%3.07 (1.39–6.78) Open table in a new tab Because the specificity of a single contact of any of these conditions is not known, we analyzed the data for having at least 5 health system contacts. We chose this number because it proved to be associated with a sensitivity and specificity of approximately 90% for Crohn’s disease and UC by self-report. By chart review, this administrative definition was associated with a sensitivity of approximately 90% for Crohn’s disease and 75% for UC, and a specificity of approximately 90% for both Crohn’s disease and UC. Five health system contacts also proved to be highly specific for a true diagnosis of multiple sclerosis in another population-based study conducted in Manitoba.7Elliott L.J. Yu N. Melanson M. Green C. Blanchard J. Application of a validated method using medical claims data to demonstrate very high prevalence and incidence of multiple sclerosis in a Canadian province.Am J Epidemiol. 2004; 159: S59Google Scholar We present the data for both at least 1 health system contact and at least 5 health system contacts. The rationale for presenting the data for both 1 and 5 health system contacts is to show that the relationships are similar in both types of analysis. This reduces the likelihood that the associations found using the 5 contact rule are caused by greater medical contact and surveillance among those with IBD because the trend and magnitude of the associations are similar even at 1 contact. The 1 contact analysis is much more sensitive because it is highly unlikely that anyone with 1 of these conditions would go for a long period without any health system contacts, and also provides an upper limit for comorbidity period prevalence. However, all statistical analyses presented and conclusions made are based on data for at least 5 contacts. Our analysis was stratified for diagnosis of Crohn’s disease vs UC and by sex and age. A matched cohort design was used. Patients with IBD in the Manitoba IBD database (see earlier) were matched 1:10 to randomly selected members of the general population by age, sex, and postal area of residence. This control cohort was extracted from the population registry of Manitoba Health. Matched controls were selected based on the date of IBD diagnosis. Data on health system contacts were obtained through the patients’ medical histories dating back to 1984 (the time at which personal health identification numbers were in use in the Manitoba Health system) and forward to 2003 for as long as the patient (IBD patient or control) remained alive and a resident of Manitoba. Hence, this is a clustering study. Period prevalence rates were calculated for the chronic diseases in Crohn’s disease, UC, and control patients and prevalence ratios were calculated to determine the likelihood of having a chronic disease comorbidity in either Crohn’s disease or UC compared with controls. This methodologic approach has been used by our group to study the associations of other disease entities with IBD patients.8Bernstein C.N. Blanchard J.F. Leslie W.D. Wajda A. Yu N. The incidence of fractures among patients with IBD a population-based study.Ann Intern Med. 2000; 133: 795-799Google Scholar, 9Bernstein C.N. Blanchard J.F. Houston D. Wajda A. The incidence of venous thromboembolic disease among patients with IBD a population-based study.Thromb Haemost. 2001; 85: 430-434Google Scholar, 10Bernstein C.N. Kliewer E. Wajda A. Blanchard J.F. The incidence of cancer among patients with IBD a population-based study.Cancer. 2001; 91: 854-862Google Scholar For controls matched to the Crohn’s disease cohort there were 15.91 ± 5.15 person-years of coverage. For controls matched to the UC cohort there were 15.99 ± 5.06 person-years of coverage. Hence, the follow-up periods were not significantly different between IBD patients and controls. Comparisons between Crohn’s disease and UC patients, between sexes and age groups (grouped by 0–19 y, 20–39 y, 40–59 y, and ≥60 y) and between IBD patients and the general population cohort yielded age-adjusted prevalence ratios (PRs). Mantel–Haenszel weights were used to calculate summary PRs based on age-specific estimates. We also conducted an analysis whereby we determined if those patients with a chronic inflammatory disease had an increased risk for either Crohn’s disease or UC. We compared the risk for either form of IBD in patients with chronic inflammatory diseases by sex and present the data for differences between women and men. The construction of the University of Manitoba IBD Database and the use of it for clinical studies was approved by the University of Manitoba Research Ethics Board and by the Access and Confidentiality Committee of Manitoba Health (now referred to as Health Information Privacy Committee). There were 8072 patients with IBD who met our administrative definitions from April 1, 1984 to March 31, 2003. This included 4193 patients with Crohn’s disease and 42,405 person-years of observation with disease and 31,365 person-years of observation without disease. There were 3879 patients with UC and 37,335 person-years of observation with disease and 31,904 person-years of observation without disease. There were 6 patients each with Crohn’s disease and UC in whom age-matched, sex-matched, and geographically matched controls could not be identified. By using a disease diagnosis definition of only 1 health system contact, all other immune diseases studied were more common among patients with UC and Crohn’s disease (Table 2, Table 3). However, using the stricter definition of 5 health system contacts rendered the diagnoses of thyroiditis, neuropathy, and myasthenia gravis not to be increased significantly in UC patients and for thyroiditis, multiple sclerosis, neuropathy, myasthenia gravis, and chronic renal disease not to be increased significantly in Crohn’s disease patients. Both UC and Crohn’s disease patients had a greater likelihood of having asthma or bronchitis, psoriasis, and pericarditis than population controls (Table 2, Table 3). All diseases were slightly more common in UC than Crohn’s disease patients, but the differences in PRs between UC and Crohn’s disease patients were not statistically significant. The PR of arthritis in UC (11.8%) and Crohn’s disease (6.3%) patients and of asthma in both UC (7.9%) and Crohn’s disease (7.1%) patients renders these diseases the most common nonintestinal comorbidity identified in our Manitoba studies.4Bernstein C.N. Blanchard J.F. Rawsthorne P. Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease a population-based study.Am J Gastroenterol. 2001; 96: 1116-1122Google Scholar, 8Bernstein C.N. Blanchard J.F. Leslie W.D. Wajda A. Yu N. The incidence of fractures among patients with IBD a population-based study.Ann Intern Med. 2000; 133: 795-799Google Scholar, 9Bernstein C.N. Blanchard J.F. Houston D. Wajda A. The incidence of venous thromboembolic disease among patients with IBD a population-based study.Thromb Haemost. 2001; 85: 430-434Google Scholar, 10Bernstein C.N. Kliewer E. Wajda A. Blanchard J.F. The incidence of cancer among patients with IBD a population-based study.Cancer. 2001; 91: 854-862Google Scholar Although arthritis is a widely recognized comorbidity in IBD, the finding of asthma as among the most common comorbidity that is increased significantly in Crohn’s disease patients compared with the general population is novel. The diagnosis of osteoarthritis occurred in 7.89% of all IBD patients combined compared with 6.13% of controls (PR, 1.37; 95% confidence interval [CI], 1.25–1.50). The diagnosis of rheumatoid arthritis occurred in 1.63% of all IBD patients combined compared with .93% of controls (PR, 1.76; 95% CI, 1.46–2.13). Among those with significantly increased PRs in UC by 5 health system contacts, compared with controls there was a greater risk among women for bronchitis, arthritis, and chronic renal disease. There was a greater PR for multiple sclerosis among men. Of all increased risks when comparing by sex, multiple sclerosis was the only disease associated with a statistically significant difference in risk in 1 sex over the other (P = .035). There were similarly increased risks for asthma, psoriasis, and pericarditis by sex (Table 4). Among those with significantly increased PRs in Crohn’s disease by 5 health system contacts, compared with controls there was a greater risk among women for bronchitis only. The increased risk was similar for women and men for asthma, arthritis, psoriasis, and pericarditis (Table 4).Table 4Comparison by Sex of PRs for Crohn’s Disease and UC Vs Controls for Selected Comorbidities Known to Be Increased Overall in Either or Both of the DiseasesSexComorbidityCrohn’s disease PR (95% CI)UC PR (95% CI)FemaleAsthma1.44 (1.23–1.69)1.65 (1.4–1.95)Male1.40 (1.13–1.73)1.67 (1.37–2.03)FemaleBronchitis2.21 (1.23–3.96)2.32 (1.28–4.22)Male1.36 (.58–3.22)1.88 (1.00–3.54)FemaleArthritis1.29 (1.10–1.50)1.71 (1.48–1.98)Male1.39 (1.10–1.75)1.33 (1.11–1.60)FemaleMultiple sclerosis1.32 (.78–2.22)1.52 (.83–2.80)Male.32 (.04–2.36)2.84 (1.35–5.97)FemaleChronic renal disease1.31 (.56–3.06)3.34 (1.31–8.49)Male1.39 (.55–3.54)2.10 (1.02–4.32)FemalePsoriasis1.50 (1.08–2.09)1.80 (1.26–2.56)Male1.74 (1.17–2.57)1.51 (1.02–2.23)FemalePericarditis.83 (.11–6.40)3.99 (1.25–12.72)Male4.99 (2.02–12.34)2.94 (1.08–7.95) Open table in a new tab There were no definite trends in terms of age groups most likely to have concurrent chronic inflammatory diseases in Crohn’s disease patients. However, in UC patients, the increased risk for multiple sclerosis was significant only in the 40- to 59-year age group (PR, 2.46; 95% CI, 1.31–4.64), the increased risk for chronic renal disease was significant only in the 20- to 39-year age group (PR, 3.70; 95% CI, 1.63–8.36), and the only significant risk for psoriasis was in the over 60-year age group (PR, 2.02; 95% CI 1.28–3.17). We analyzed the data by assessing all patients with chronic inflammatory diseases for the likelihood of having either Crohn’s disease or UC (Table 5). Patients with asthma, arthritis, or psoriasis had increased risks for having either Crohn’s disease or UC, with comparably increased risks among men and women. Female patients with bronchitis (PR, 1.98; 95% CI, 1.23–3.19) had a significantly increased risk for Crohn’s disease but men did not (PR, 1.32; 95% CI, .62–2.80). Both men and women with bronchitis had similar increased risks for UC. Men (PR, 3.67; 95% CI, 2.00–6.73), but not women (PR, .85; 95% CI, .13–5.56) with pericarditis had an increased risk for Crohn’s disease whereas both men and women with pericarditis had similar increased risks for UC. Men with multiple sclerosis had an increased risk for having UC (PR, 2.42; 95% CI, 1.36–4.31) but women did not (PR, 1.45; 95% CI, .86–2.46). Both women (PR, 2.75; 95% CI, 1.37–5.51) and men (PR, 1.41; 95% CI, 1.05–3.46) with chronic renal diseases had increased risks for UC but this risk was greater among women.Table 5The PRs (95% CIs) of Having IBD if a Person Has a Diagnosis of Other Chronic Inflammatory DiseaseCrohn’s diseaseUCAsthma1.38 (1.23–1.53)1.56 (1.4–1.74)Bronchitis1.72 (1.15–2.58)1.92 (1.35–2.73)Arthritis1.24 (1.11–1.38)1.41 (1.28–1.54)Multiple sclerosis1.10 (.7–1.73)1.75 (1.18–2.60)Neuropathy.76 (.9–1.95)1.40 (.70–2.80)Myasthenia gravisaPR estimates not computed because of small cell sizes.1.57 (.55–4.48)Chronic renal disease1.30 (.75–2.27)2.17 (1.38–3.42)Pericarditis2.59 (1.41–4.75)2.75 (1.56–4.85)Psoriasis1.52 (1.22–1.89)1.56 (1.24–1.95)Thyroiditis.85 (.42–1.74)1.50 (.82–2.75)a PR estimates not computed because of small cell sizes. Open table in a new tab When using the 5-claim definition for each diagnosis, 63% of chronic inflammatory diseases were diagnosed before IBD was diagnosed. A number of case reports and case series have suggested that the chronic inflammatory diseases we studied are increased in patients with IBD. A recent case-control study was performed at the Mayo Clinic.11Ricart III, E. Tremaine W. Harmsen W.S. Zinsmeister A.R. Sandborn W.J. Autoimmune disorders and extraintestinal manifestations in first degree familial and sporadic inflammatory bowel disease a case-control study.Inflamm Bowel Dis. 2004; 10: 207-214Google Scholar In that study, 243 patients with IBD presenting to the specialty clinic at Mayo Clinic were enrolled over an 8-month period. Controls were identified from outpatients seen at the Mayo Clinic who did not have IBD and were matched to IBD patients by age, sex, and geographic residence. This study found an increased prevalence of classic extraintestinal manifestations (40% vs 14%) and the odds ratio (OR) for being diagnosed with IBD and any of theses extraintestinal manifestations was 2.9 (95% CI, 1.9–4.2). A total of 10% of IBD patients had 1 or more autoimmune diseases compared with 19% of matched control patients. Having an IBD diagnosis conferred a lower risk for acquiring any autoimmune disease (OR, .4; 95% CI, .1–.96). The most common autoimmune disorder was autoimmune thyroid disease, however, there were fewer cases of autoimmune thyroid disease and systemic lupus erythematosus among IBD patients compared with control patients. Psoriasis and multiple sclerosis were no more common in IBD patients than in control patients. The Mayo Clinic study differed from our study in several ways. The Mayo Clinic study was considerably smaller than the Manitoba study. The Manitoba study had the advantage of using population-based data, making it less likely we would have missed previously diagnosed autoimmune diseases. Also, the Mayo Clinic has a referral bias and control patients may have an increased prevalence of autoimmune disease. However, the Mayo Clinic study had the advantage of diagnosis confirmation. To enhance the likelihood of assessing true diagnoses of the comorbid diseases in question we have based our conclusions on a measure of 5 health system contacts. This has proven to be very specific in diagnosing Crohn’s disease, UC, and multiple sclerosis in Manitoba.6Bernstein C.N. Blanchard J.F. Rawsthorne P. Wajda A. The epidemiology of Crohn’s disease and ulcerative colitis in a central Canadian province a population-based study.Am J Epidemiol. 1999; 149: 916-924Google Scholar, 7Elliott L.J. Yu N. Melanson M. Green C. Blanchard J. Application of a validated method using medical claims data to demonstrate very high prevalence and incidence of multiple sclerosis in a Canadian province.Am J Epidemiol. 2004; 159: S59Google Scholar The Mayo Clinic study did assess for rheumatoid arthritis and systemic lupus erythematosus, but not osteoarthritis, a disorder considered more degenerative and less inflammatory in the classic sense. We assessed for both of these forms of arthritis and other connective tissue disorders because it is not clear how physicians would code diagnostically for the arthritis that occurs in IBD. Although we found a higher relative risk for the classically immune-mediated arthritis (rheumatoid arthritis)" @default.
• W2092190921 created "2016-06-24" @default.
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• W2092190921 date "2005-09-01" @default.
• W2092190921 modified "2023-10-06" @default.
• W2092190921 title "The Clustering of Other Chronic Inflammatory Diseases in Inflammatory Bowel Disease: A Population-Based Study" @default.
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