Gastroenterology

Gastroenterology

Volume 123, Issue 3, September 2002, Pages 714-718
Gastroenterology

Clinical–Alimentary Tract
Uveitis and erythema nodosum in inflammatory bowel disease: Clinical features and the role of HLA genes,☆☆

https://doi.org/10.1053/gast.2002.35396Get rights and content

Abstract

Background & Aims: There are few systematic studies on the natural history or immunogenetic associations of erythema nodosum (EN) or ocular inflammation in inflammatory bowel disease (IBD), but they are reportedly more common in patients with other extraintestinal manifestations (EIMs), particularly arthritis. Immunogenetic associations have previously been described in IBD arthritis and in EN associated with sarcoidosis. This study examined the clinical features and HLA-B, DR, and tumor necrosis factor α (TNF-α) associations of ocular inflammation and EN and their clinical and immunogenetic relationship to arthritis in IBD. Methods: Details of EN and ocular inflammation were gathered by case-note review and questionnaire in 976 ulcerative colitis patients and 483 Crohn's patients. Sequence-specific PCR typing for polymorphisms in HLA-B, DR, and TNF-α was performed in 39 EN and 40 ocular patients. Results were compared with 490 IBD controls without EIMs, 38 patients with type 1 and 31 with type 2 peripheral arthritis, and 16 AS patients. Results: EN and ocular inflammation were more common in women, were associated with IBD relapse, and recurred in approximately 30% of patients. They occurred more commonly with arthritis and AS than expected by chance. Ocular inflammation was strongly associated with HLA-B*27, B*58, and HLA-DRB1*0103. There is a weak association between EN and HLA-B*15 but a strong association with the −1031 TNF-α. Conclusions: EN, uveitis, and arthritis associated with IBD occur together commonly. They are associated with genes in the HLA region, and linkage disequilibrium between these genes may account for the clinical picture of overlapping but independent clinical manifestations.

GASTROENTEROLOGY 2002;123:714-718

Section snippets

Patient selection

The case notes of 976 UC patients and 483 Crohn's disease patients attending the Oxford Inflammatory Bowel Disease Clinic were reviewed as previously described,12 and information on the general nature of the bowel disease and EIMs was obtained. This information was validated by a questionnaire regarding EIMs administered in the Outpatient department at routine follow-up visits. All patients who had suffered from AS, peripheral arthritis, EN, or acute ocular inflammation were identified from the

Clinical features

There were 39 patients with EN (29 of 483 Crohn's disease [6%] and 10 of 976 UC [1%]) and 50 patients with ocular inflammation (25 of 483 Crohn's disease [5%] and 25 of 976 UC [3%]). The clinical features of EN and ocular complications are shown in Table 1.

. Clinical features of EN and uveitis in IBD

Empty CellErythema nodosum (n = 39)Ocular inflammation (n = 50)
Female:male ratio33:6 (5.5:1)35:15 (2.3:1)
Present at or before diagnosis (%)20 (51)11 (22)
Related to IBD activity (%)36 (92)39 (78)
Recurrent

Discussion

This study delineates clearly the clinical features of EN and acute ocular inflammation in IBD. They are both more common in women (strikingly so in the case of EN) and are both associated with active gut disease. EN is associated with the presence of colonic Crohn's disease, but there is no association with site of disease in uveitis or in EN associated with UC.

EN is nearly always self-limiting, with a maximum duration of 12 weeks in this population. In addition, after acute ocular

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Address requests for reprints to: Timothy Orchard, M.D., University of Oxford, Woodstock Road, Oxford OX2 6HE, United Kingdom. e-mail: [email protected]; fax: (44) 207-886-1138.

☆☆

Supported partly by the Arthritis Research Campaign (ARC; to T.R.O.) and by the National Association for Colitis and Crohn's disease (NACC; to T.A.).

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