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Published on: September 22, 2019
Childhood-onset inflammatory bowel disease and chronic non-bacterial osteomyelitis: a Swedish nationwide cohort study
Marianne Malmquist1,2, Siri Voghera3,
1Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Children with childhood-onset inflammatory bowel disease (IBD) have a significantly higher risk of developing chronic non-bacterial osteomyelitis (CNO). This study highlights key differences in patients with both IBD and CNO, including earlier onset and more frequent extraintestinal issues.
Area of Science:
- Pediatric Rheumatology
- Pediatric Gastroenterology
- Epidemiology
Background:
- Chronic non-bacterial osteomyelitis (CNO) is a rare condition.
- Population-based studies on CNO in childhood-onset inflammatory bowel disease (IBD) are scarce.
Purpose of the Study:
- To investigate the association between childhood-onset IBD and the risk of CNO.
- To compare clinical characteristics of IBD patients with and without CNO.
Main Methods:
- Utilized nationwide Swedish registers (2002-2022) to identify children with IBD and CNO.
- Employed Cox regression to analyze temporal associations between IBD and CNO.
- Compared clinical data between IBD patients with CNO (IBD+CNO) and those without CNO.
Main Results:
- Identified 8,244 children with IBD and 82,400 non-IBD comparators.
- Found a 6-fold increased risk of CNO in the IBD cohort (aHR=5.87).
- IBD+CNO patients had earlier IBD onset (median 11 vs 14 years), more extraintestinal manifestations (62% vs 21%), and higher biologic use (78% vs 44%).
Conclusions:
- Childhood-onset IBD is associated with a substantially increased risk of CNO.
- IBD patients who develop CNO present with distinct clinical features, including younger age at diagnosis and more comorbidities.
Background And Aims:
Nationwide, population-based studies of chronic non-bacterial osteomyelitis (CNO) in patients with childhood-onset inflammatory bowel disease (IBD) are lacking.
Methods:
We used nationwide registers to identify all children in Sweden diagnosed with IBD during 2002-2022 and the occurrence of CNO in this IBD cohort and general population non-IBD comparators. To estimate the temporal associations between IBD and CNO we used Cox regression. We compared clinical data for IBD patients with CNO (IBD+CNO) and the IBD patients without CNO.
Results:
We identified 8244 children with IBD and 82 400 non-IBD comparators. At IBD diagnosis, CNO had been diagnosed in 0.13% (11/8244) of the IBD cohort and 0.03% (26/82 400) of the non-IBD comparators. During follow-up, 13 additional CNO cases occurred in the IBD cohort and 22 in the non-IBD comparators (adjusted hazard ratio = 5.87 [95% CI 2.95-11.66]). The prevalence of CNO among all prevalent children with IBD and prevalent matched non-IBD comparators December 31, 2022 was 0.48% (9/1885) and 0.02% (4/18 567), respectively. Median age at IBD diagnosis was lower in IBD + CNO compared to IBD without CNO (11 vs 14 years [-3 years, 95% CI -5 to -1]). Extraintestinal manifestations (except CNO) were more frequent in IBD + CNO (62% vs 21%, P < .0001). Treatment with biologics was more common in the IBD + CNO group (78% vs 44%, P = .004), prescribed for IBD and/or CNO.
Conclusions:
We found a 6-fold increased risk of CNO in childhood-onset IBD compared to non-IBD comparators. Patients with IBD + CNO are characterized by younger age at IBD onset, more frequent extraintestinal manifestations, and higher usage of biologics.
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