P163 Emergence/exacerbation of inflammatory bowel disease in patients receiving secukinumab for ankylosing spondylitis -case series

Abstract Background Secukinumab is a monoclonal antibody targeting interleukin-17A and is commonly used for managing autoimmune diseases such as, psoriasis, psoriatic arthritis, and ankylosing spondylitis. Prior studies have suggested that anti-IL17 therapy may worsen symptoms in patients with pre-existing inflammatory bowel disease (IBD). However, it remains unclear if secukinumab is associated with new-onset IBD or in provoking a flare of previously quiescent IBD. Aims We evaluated patients referred to our IBD clinic who developed intestinal inflammation after starting secukinumab for the management of autoimmune diseases. Methods We performed a retrospective, observational study at a single tertiary care center between 2017 and 2020. Patients referred to our IBD clinic who developed intestinal inflammation after starting secukinumab were included. We excluded patients with an established pre-existing diagnosis of IBD and patients who had positive stool testing for infectious organisms. Patient demographics, disease characteristics, distribution of intestinal inflammation and clinical outcomes were assessed. The pathology slides were reinterpreted by a single pathologist with a specialty in gastroenterology to determine the histologic characteristics of the inflammation. Results A total of 8 patients developed gastrointestinal symptoms after starting secukinumab: 4 (50%) males with a median age of 42.5 (IQR: 35–50 years old). Secukinumab was initiated for psoriasis in 3 (37.5%) patients, psoriatic arthritis in 2 (25%) patients, ankylosing spondylitis in 2 (25%) patients and juvenile idiopathic arthritis in 1 (12.5%) patient. The median time of onset for gastrointestinal symptoms after starting secukinumab was 7 months (IQR: 4–15 months). Of the patients who underwent testing for inflammatory biomarkers, the median CRP was 25.5 (IQR 25.4–34.2). Endoscopic disease distribution involved the colon in 5 (62.5%) patients and the ileum and colon in 3 (37.5%) patients. In this series of patients, the histologic characteristics demonstrated three patterns of colitis: IBD-like (ulcerative colitis or Crohn’s disease) in 6 (75%) patients based on mucosal granulomas and/or chronic inflammatory changes, MMF-like histology in 1 (12.5%) patient, characterized by an abundance of intraepithelial eosinophils in the lamina propria and numerous crypt apoptotic bodies, and finally active colitis in 1 (12.5%) patient characterized by an absence of chronic mucosal injury or granulomas. The treatment for these patients was cessation of secukinumab and initiating alternative therapies with close clinical monitoring. Conclusions In this small case series, Secukinumab was temporally associated with the development of gastrointestinal inflammation. Further larger studies are required to confirm this association and to determine if IL-17 contributes to the pathogenesis of IBD. Funding Agencies None

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Congenital Chloride Diarrhea and Childhood Inflammatory Bowel Disease: A Multicenter Case Series

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa333 ◽

2020 ◽

Author(s):

Mohammed Hasosah ◽

Amirah Alqahtani ◽

Ali Almehaidib ◽

Mansour Qurashi

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Case Series ◽

Congenital Chloride Diarrhea ◽

Inflammatory Bowel

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Lymphoma in Pediatric-Onset Inflammatory Bowel Disease Treated with Infliximab Monotherapy: A Case Series

Digestive Diseases and Sciences ◽

10.1007/s10620-021-06884-9 ◽

2021 ◽

Cited By ~ 1

Author(s):

Alejandro Llanos-Chea ◽

Jason M. Shapiro ◽

Rachel W. Winter ◽

Logan Jerger ◽

Timothy Menz ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Case Series ◽

Inflammatory Bowel ◽

Pediatric Onset

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Vitamin C Deficiency in Inflammatory Bowel Disease: The Forgotten Micronutrient

Crohn's & Colitis 360 ◽

10.1093/crocol/otab009 ◽

2021 ◽

Author(s):

Katie A Dunleavy ◽

Ryan C Ungaro ◽

Laura Manning ◽

Stephanie Gold ◽

Joshua Novak ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Vitamin C ◽

Bowel Disease ◽

Fruits And Vegetables ◽

Nutritional Assessment ◽

Care Center ◽

Tertiary Care ◽

Case Series ◽

Vitamin C Deficiency ◽

Inflammatory Bowel

Abstract Background Micronutrient deficiencies are common in patients with inflammatory bowel disease (IBD). To date, the literature has focused on vitamin D, vitamin B12, and iron deficiencies. Methods We report a case series of 20 patients with IBD and vitamin C deficiency treated at a single tertiary care center. Results Sixteen (80%) patients had symptoms of clinical scurvy, including arthralgia, dry brittle hair, pigmented rash, gingivitis, easy bruising and/or brittle nails. Eighteen patients underwent a nutritional assessment, 10 (56%) patients reported complete avoidance of fruits and vegetables, and 3 (17%) reported reduced intake of fruits and vegetables. Conclusions Vitamin C deficiency should be considered in IBD patients, particularly those with reduced fruit/vegetable intake, as it can lead to significant signs and symptoms.

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AB0702 THE FREQUENCY OF INFLAMMATORY BOWEL DISEASES IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3798 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1647.2-1647

Author(s):

G. Lukina ◽

P. Kulakova ◽

N. Savenkova ◽

E. Volnukhin ◽

A. Kovshik ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Longitudinal Study ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Bowel Disease ◽

Rapid Test ◽

Neutrophil Infiltration ◽

Fecal Calprotectin ◽

High Disease Activity ◽

Inflammatory Bowel

Background:Аnkylosing Spondylitis (AS) is closely associated with inflammatory bowel disease (IBD). About 6-46% of patients with IBD have various lesions of the musculoskeletal system [1]. 5-10% of patients with spondylarthritis (SpA) eventually develop IBD, with Crohn’s disease (CD) being more common than Ulcerative colitis (UC) [2]. Determining the level of fecal calprotectin (FC) is a study that allows to diagnose IBD. The concentration of FC directly depends on the neutrophil infiltration of the intestinal mucosa and has a direct connection with the activity of the inflammatory process [3]. It is known that level of FC increases in 2/3 of patients with AS and is closely related to parameters reflecting higher disease activity [4].Objectives:The aim of this study was to evaluate the frequency of IBD in patients with AS using an assessment of FC level.Methods:In the analysis were included 40 patients with AS, fulfilling the modified New York criteria, among them man -26 (65%), woman -14 (35%), mean age of patients was 41.2 ±10.5, mean disease duration - 13±8.8 years. All patients were examined with ESR, CRP, esophagogastroduodenoscopy, colonoscopy and quantitative analysis of the fecal calprotectin levels using the method of lateral immunochromatography with the BUHLMANN Quantum Blue rapid test. Standart range: 100-1800 µg /g.Results:All patients had a high disease activity, mean BASDAI was 5.2 ± 1.7, mean ASDAS CRP 3.8 ± 1.1. 35 patients (87.5 %) had FC level more than 100 µg / g, the remaining 5 patients (12.5%) less than 100 µg /g. 12 patients (30 %) had FC level more than 1,800 µg / g, 23 (57.5 %) from 101 µg / g to 1800 µg / g. All patients with FC levels more than 100 µg / g showed an increase CRP (mean 28.4 mg / l) and ESR (mean 36.3 mm\h) levels. IBD were diagnosed in 9 cases (22.5%): 5 patients (12.5 %) with CD and 4 patients (10 %) - UC, in the remaining cases (77.5%) was no intestinal pathology.Conclusion:The results showed high frequency of IBD in patients with AS. Patients with high FC levels (more than 100 μg/g) had high disease activity (AS). In most cases, inflammatory bowel disease were diagnosed in patients with FC levels more than 100 µg/g.References:[1] Bernstein CN, Blanchard JF, Rawsthorne P, Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2001 Apr;96(4):1116-22.[2] Klingberg, E., Strid, H., Stahl, A.et al. A longitudinal study of fecal calprotectin and the development of inflammatory bowel disease in ankylosing spondylitis. A longitudinal study of fecal calprotectin and the development of inflammatory bowel disease in ankylosing spondylitis. Arthritis Res Ther 2017. 19(1):21[3] Cypers H, Varkas G, Beeckman S, et al. Elevated calprotectin levels reveal bowel inflammation in spondyloarthritis. Annals of the Rheumatic Diseases. 2016. 75:1357-1362[4] Arzu Duran, Senol Kobak, Nazime Sen, et al. Fecal calprotectin is associated with disease activity in patients with ankylosing spondylitis. Bosnian Journal of Basic Medical Sciences. 2016. 16 (1):71-4Disclosure of Interests:Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Polina Kulakova: None declared, Nadezhda Savenkova: None declared, Evgeniy Volnukhin: None declared, Anton Kovshik: None declared, Elena Alexandrova: None declared, Alexandr Novikov: None declared

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Mo1884 - Drug Survival of Vedolizumab-Treated Inflammatory Bowel Disease Patients in a Nationwide Observational Cohort Study: ICC Case Series

Gastroenterology ◽

10.1016/s0016-5085(18)32848-8 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-838

Author(s):

Vince Biemans ◽

Christien Janneke Van Der Woude ◽

Gerard Dijkstra ◽

Andrea Van Der Meulen ◽

Bas Oldenburg ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Cohort Study ◽

Bowel Disease ◽

Case Series ◽

Observational Cohort Study ◽

Drug Survival ◽

Observational Cohort ◽

Inflammatory Bowel

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Henoch Schonlein purpura in pediatric patients with inflammatory bowel disease: A case series

Pediatric Dermatology ◽

10.1111/pde.14818 ◽

2021 ◽

Author(s):

Anjani P. Sheth ◽

Karina L. Vivar ◽

Annette M. Wagner ◽

Lacey L. Kruse

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Pediatric Patients ◽

Case Series ◽

Henoch Schonlein Purpura ◽

Inflammatory Bowel ◽

Schonlein Purpura ◽

Henoch Schönlein Purpura

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Lipocalin 2 links inflammation and ankylosis in the clinical overlap of inflammatory bowel disease (IBD) and ankylosing spondylitis (AS)

Arthritis Research & Therapy ◽

10.1186/s13075-020-02149-4 ◽

2020 ◽

Vol 22 (1) ◽

Author(s):

Aifeng Lin ◽

Robert D. Inman ◽

Catherine J. Streutker ◽

Zhenbo Zhang ◽

Kenneth P. H. Pritzker ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Ankylosing Spondylitis ◽

Bowel Disease ◽

Lipocalin 2 ◽

Inflammatory Bowel

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Sulphasalazine-Induced Pseudomembranous Colitis

Canadian Journal of Gastroenterology ◽

10.1155/1991/420864 ◽

1991 ◽

Vol 5 (5) ◽

pp. 167-170 ◽

Cited By ~ 4

Author(s):

Hugh J Freeman ◽

Urs P Steinbrecher ◽

WC Peter Kwan ◽

Stephanie Ensworth

Keyword(s):

Inflammatory Bowel Disease ◽

Abdominal Pain ◽

Ankylosing Spondylitis ◽

Clostridium Difficile ◽

Bowel Disease ◽

Pseudomembranous Colitis ◽

Flexible Sigmoidoscopy ◽

Frequent Use ◽

Toxin Assay ◽

Inflammatory Bowel

An 18-year-old female with ankylosing spondylitis developed fever, abdominal pain and diarrhea on two occasions after starting sulphasalazine therapy. Flexible sigmoidoscopy revealed pseudomembranous colitis; fecal cultures were positive forClostridium difficile; andC difficiletoxin assay was positive. Despite the frequent use of sulphasalazine in the management of inflammatory bowel disease, this complication has been apparently rare. Clinicians should be wary of the onset of diarrhea in patients receiving sulphasalazine, whether for inflammatory bowel disease or other conditions.

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