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Chronobiological aspects of adult-onset Crohn disease
Miroslav Mikulecký1, Jozef Rovenský, Zlata Kmecová
11st Medical Clinic, Comenius University, Bratislava, Slovakia.
Insights
Crohn disease activity fluctuates with seasons, showing higher interleukin-6 levels and lower bone density in spring. Monitoring disease course over time is crucial for effective treatment strategies.
Area of Science:
- Gastroenterology and Immunology
- Chronobiology
- Bone Metabolism
Background:
- Crohn disease is a chronic inflammatory condition with complex etiology.
- Understanding the temporal patterns of Crohn disease activity is essential for optimizing patient management.
- Previous research has explored various factors influencing disease progression, but seasonal variations require further investigation.
Purpose of the Study:
- To investigate the time course and seasonal variations of Crohn disease activity and related biomarkers.
- To compare findings with existing global literature and inform clinical practice.
- To analyze the impact of age and disease duration on disease manifestations.
Main Methods:
- Retrospective analysis of 56 patients (31 males, 25 females) with Crohn disease.
- Measurement of plasma interleukin-6 levels and bone mineral density (T-score).
- Application of Halberg cosinor regression for seasonality analysis and quadratic regression for age/duration effects.
Main Results:
- Identified significant seasonality in patient births and a spring elevation in interleukin-6 levels, disease activity index, and decreased bone density.
- Observed increased interleukin-6 levels up to age 41 in active disease patients.
- Found a significant decrease in bone density paralleling disease duration up to seven years in the active disease subgroup.
Conclusions:
- The temporal course of Crohn disease, including seasonal influences, is significant.
- Clinical practice should incorporate regular monitoring of disease progression over time for timely interventions.
- Discrepancies with global literature may stem from geographical and methodological differences.
Purpose:
To study the time course of Crohn disease and its signs. To compare the results with the world literature and draw conclusions for practice.
Basic Procedures:
Fifty-six patients were studied retrospectively: 31 males aged 19-48 years with disease duration 1-8 years, and 25 females aged 21-65 with disease duration 1-13 years. The disease was active (Crohn disease activity index > 150) in 25 patients and inactive in 31. Plasma levels of interleukin-6 (normal upper value 8 pg/ml) were investigated with radioimmunoassay. Bone mineral density was measured as the T-score (normal range between -1 and 0 standard deviations) in the forearm using dual-energy X-ray absorptiometry. The seasonality of births of the patients in relation to the total Slovak population and seasonality of severity of three important disease signs were examined with Halberg cosinor regression. The dependence of the signs on age and duration of disease was evaluated using quadratic regression. Results are presented as 95% confidence intervals (for means) and 95% tolerance intervals (for individuals). The level of statistical significance was set at alpha = 0.05.
Main Findings:
Significant seasonality in births was found: decreased frequency in May-June and increased frequency in September-January. Significant spring elevation of interleukin-6 levels, accompanied by significant spring rise of the disease activity index and by decrease of bone density, is described. Among patients with active disease, interleukin-6 levels significantly increased up to the age of 41 years, whereas linear increase of disease activity during aging was on the borderline level of significance in the same subgroup. No significant age trend was encountered in T-score for either subgroup. The same was true for interleukin-6 and disease activity versus duration. Significant decrease in T-score paralleled disease duration up to seven years in the subgroup with active disease.
Principal Conclusions:
The course of Crohn disease is influenced by time, including the seasons of the year. However, this does not find full agreement in the world literature, probably because of geographic, socioeconomic and epidemiologic differences, as well as varying approaches in method. In practice, regular monitoring of the time course is necessary in provision of appropriately timed treatment.
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