1. IgA vasculitis in patients with inflammatory bowel disease: new insights into the role of TNF-α blockers.
- Author
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Rasmussen C, Abitbol V, El Karoui K, Bourrier A, Paule R, Vuitton L, Maurier F, Laharie D, Fuméry M, Agard C, Collins M, Nancey S, Rafat C, Kervegant AG, Queyrel-Moranne V, Moulis G, Pigneur B, Régent A, Gay C, Morbieu C, Durel CA, Ducloux D, Aubin F, Voicu M, Joher N, Szwebel T, Martinez-Vinson C, Koch S, Guillevin L, Peyrin-Biroulet L, and Terrier B
- Subjects
- Humans, Immunoglobulin A, Recurrence, Retrospective Studies, Tumor Necrosis Factor Inhibitors adverse effects, Tumor Necrosis Factor-alpha, Antineoplastic Agents therapeutic use, IgA Vasculitis, Inflammatory Bowel Diseases drug therapy, Vasculitis chemically induced
- Abstract
Objective: The association of IgA vasculitis (IgAV) and IBD is rarely described, mainly during anti-TNF-α therapy. We aimed to describe the association of IgAV and IBD., Methods: We retrospectively analysed the association of IgAV and IBD through the implication of the GETAID and FVSG networks. Characteristics of IBD and IgAV were collected using a standardized case report form., Results: Forty-three cases were included. IBD [mainly Crohn's disease (CD) in 58%] preceded IgAV in 38 (88%), with median interval of 9.2 (IQR 5.4-15.4) years. In these 38 patients, at IgAV diagnosis, five (13%) had active IBD and 28 (74%) were treated with anti-TNF-α for a median duration of 31.5 (IQR 19-56) months. Main IgAV manifestations were purpura all patients (100%), joints in 20/35 (57%), renal in 15/35 (43%) and gastrointestinal in 11/35 (31%) involvement. IgAV was treated with glucocorticoids in 25 (66%), colchicine in six (16%), CYC in six (16%) and anti-TNF-α were discontinued in 15/28 (54%). No IgAV relapse occurred when TNF-α blockers were stopped, vs 23% in patients pursuing it. Conversely, five (33%) had IBD flare or complication after anti-TNF-α cessation vs one (8%) in those continuing biologics. Anti-TNF-α were resumed in six (40%), with subsequent IgAV relapse in four (67%)., Conclusions: This large cohort suggests that TNF-α blockers may promote the onset of IgAV in IBD. Discontinuation of anti-TNF-α was associated with vasculitis remission but increased risk of IBD relapses, whereas continuation of anti-TNF-α was associated with IBD remission but vasculitis relapse., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2022
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