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Factors Predicting Remission and Disease Progression of Pyoderma Gangrenosum Lesions in Patients With Inflammatory Bowel Disease
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Factors Predicting Remission and Disease Progression of Pyoderma Gangrenosum Lesions in Patients With Inflammatory Bowel Disease
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Journal Article
Factors Predicting Remission and Disease Progression of Pyoderma Gangrenosum Lesions in Patients With Inflammatory Bowel Disease
2018
Overview
Introduction: Pyoderma Gangrenosum (PG) is a rare, extra-intestinal manifestation of inflammatory bowel disease (IBD). Due to its rarity, very few studies have analyzed factors associated with remission and recurrence of PG lesions. We conducted this study to determine the underlying disease characteristics and factors predicting remission of PG lesions. Methods: We conducted a retrospective cohort study of IBD patients with PG from 2010 to 2016. PG lesions were followed longitudinally for 12 months from the point of diagnosis. Details of the PG lesions including the number, size, site, treatments, qualitative change in lesions and concurrent clinical and endoscopic severity of IBD and treatments were recorded at each follow-up. A time-to-event analysis was performed to evaluate PG remission. Kaplan-Meier plots were constructed and unadjusted Cox regression analysis was performed to assess associations between baseline factors and remission. Results: Of 46 IBD (Crohn's disease [CD]=29; Ulcerative colitis [UC] = 17) patients with PG, majority were females (70%), Caucasian (80%) and mean age at PG diagnosis was 53.1± 13 years (table 1). Average IBD duration at the time of PG diagnosis was 18.6±12.5 years. PG lesions were most common in Peri-stomal region (50%) and lower extremity (46%). Median area of PG lesions was 3cm2and median number of PG lesions was 2. Intra-lesional steroids (44.4%) and systemic steroids (39.1%) were the most commonly used treatment for PG. There was a significant improvement in the lesion status, area of the lesion and number of lesions across the study period (figure 1). Overall 78.2% patients achieved remission (n=36/46) and 72.2% patients were in remission from PG at 12-month follow-up (figure 2). There was no significant difference in healing of PG lesions between CD and IBD patients (p=0.63). Of 26 patients who followed up after remission, recurrence rate was 24% patients at 6-month follow up. Majority of the patients were in clinical (43.5%) and endoscopic remission (55.3%) at PG diagnosis. Incidence of any IBD related surgery (p=0.014) and Ileostomy (0.005) prior to PG diagnosis was higher in CD as compared to UC. Conclusion: Approximately three out of four patients achieved healing of PG lesions at one year follow up period. Use of systemic steroids increased the chances of healing, whereas patients with hypertension and hyperlipidemia were less likely to achieve remission. Further prospective studies are required to substantiate these results.
Publisher
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
