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The association between erythema nodosum and pyoderma gangrenosum and pediatric inflammatory bowel disease
Miranda L Yousif1, Andrew Ritchey2, Lucia Mirea2
1College of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.
Insights
Erythema nodosum (EN) and pyoderma gangrenosum (PG) in pediatric inflammatory bowel disease (IBD) patients are linked to increased disease severity and other non-skin issues like arthritis and uveitis. A small number of patients experienced both EN and PG.
Area of Science:
- Pediatric gastroenterology
- Dermatology
- Clinical research
Background:
- Inflammatory bowel disease (IBD) encompasses chronic gastrointestinal conditions.
- Erythema nodosum (EN) and pyoderma gangrenosum (PG) are inflammatory skin manifestations that can occur in IBD patients.
- Understanding the prevalence and associated factors of EN and PG in pediatric IBD is crucial for comprehensive patient care.
Purpose of the Study:
- To determine the incidence rates of EN and PG in pediatric patients diagnosed with IBD.
- To identify patient-level and visit-level factors associated with the development of EN and PG in this population.
Main Methods:
- A longitudinal cohort study design was employed, analyzing data from the ImproveCareNow (ICN) registry.
- Data from 32,497 pediatric patients (age ≤21 years) across 285,913 visits were included.
- Longitudinal logistic regression models were used to assess associations between various factors and the presence of EN/PG, controlling for time and patient clustering.
Main Results:
- The incidence of EN was 1.57% and PG was 0.90% among pediatric IBD patients.
- A co-occurrence of EN and PG was observed in 0.30% of patients.
- Both EN and PG were significantly associated with increased IBD severity, lower remission rates, elevated inflammatory markers, and other extraintestinal manifestations (EIMs) such as arthritis and uveitis.
Conclusions:
- EN and PG in pediatric IBD are indicators of heightened disease severity and are linked to other non-cutaneous EIMs, specifically arthritis and uveitis.
- A small proportion of pediatric IBD patients may experience both EN and PG concurrently.
- These findings underscore the importance of monitoring for dermatologic manifestations in pediatric IBD management.
Objectives:
The objectives of this study is to estimate rates and identify factors associated with erythema nodosum (EN) and pyoderma gangrenosum (PG) in pediatric patients with inflammatory bowel disease (IBD).
Methods:
This cohort study examined longitudinal visits of patients aged ≤ 21 years from the ImproveCareNow (ICN) registry. We evaluated the association of factors at the patient-level (demographics and IBD diagnosis age) and visit-level (IBD severity scores, markers and phenotypes, comorbidities, and treatment) with the presence of EN and PG, using longitudinal logistic regression models adjusted for time and within-patient clustering.
Results:
A total of 285,913 visits from 32,497 patients aged ≤ 21 years from the ICN registry were analyzed. The occurrence of EN was 1.57% (95% confidence interval [95% CI]: 1.43%-1.71%) and the occurrence of PG was 0.90% (95% CI: 0.80%-1.00%). Co-occurrence of EN and PG was reported in 0.30% (95% CI: 0.25%-0.37%) patients. Both EN and PG were associated (p < 0.0001) with worse intestinal disease, lower remission, higher inflammatory markers, and extraintestinal manifestations (EIMs) arthritis and uveitis.
Conclusions:
EN and PG were associated with increased disease severity and other noncutaneous EIMs (arthritis and uveitis). A small subset of patients had developed both EN and PG.
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