title: Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature.
abstract: BACKGROUND
  Published small case series suggest that inflammatory bowel disease [IBD; Crohn's disease (CD) or ulcerative colitis (UC)] and vasculitis co-occur more frequently than would be expected by chance.
  
  
  OBJECTIVE
  To describe this association by an analysis of a large cohort of carefully studied patients and through a systematic literature review.
  
  
  METHODS
  Patients with both IBD and vasculitis enrolled in the Vasculitis Clinical Research Consortium (VCRC) Longitudinal Studies, followed in Canadian Vasculitis research network (CanVasc) centers and/or in the University of Toronto's IBD clinic were included in this case series. A systematic literature review of patients with IBD and vasculitis involved a PubMed search through February 2014. The main characteristics of patients with Takayasu arteritis (TAK) and IBD were compared to those in patients with TAK without IBD followed in the VCRC.
  
  
  RESULTS
  The study identified 32 patients with IBD and vasculitis: 13 with large-vessel vasculitis [LVV; 12 with TAK, 1 with giant cell arteritis (GCA); 8 with CD, 5 with UC]; 8 with ANCA-associated vasculitis [AAV; 6 granulomatosis with polyangiitis (GPA), 2 with eosinophilic granulomatosis with polyangiitis (EGPA)]; 5 with isolated cutaneous vasculitis; and 6 with other vasculitides. Patients with LVV and AAV were mostly female (18/21). The diagnosis of IBD preceded that of vasculitis in 12/13 patients with LVV and 8/8 patients with AAV. The review of the literature identified 306 patients with IBD and vasculitis: 144 with LVV (133 TAK; 87 with IBD preceding LVV), 19 with AAV [14 GPA, 1 EGPA, 4 microscopic polyangiitis (MPA)], 66 with isolated cutaneous vasculitis, and 77 with other vasculitides. Patients with IBD and TAK were younger and had more frequent headaches, constitutional symptoms, or gastrointestinal symptoms compared to those patients in the VCRC who had TAK without IBD.
  
  
  CONCLUSIONS
  These findings highlight the risk of vasculitis, especially TAK, in patients with IBD (both CD and UC).
authors: Division of Rheumatology, Mount Sinai Hospital, University of Toronto, The Joseph and Wolf Lebovic Building, 60 Murray St, Ste 2-220, Toronto, Ontario, Canada M5T 3L9.
authors: Alice
authors: A
authors: Sy
authors: Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada.
authors: Nader
authors: N
authors: Khalidi
authors: Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Natasha
authors: N
authors: Dehghan
authors: Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada.
authors: Lillian
authors: L
authors: Barra
authors: Division of Rheumatology, Mount Sinai Hospital, University of Toronto, The Joseph and Wolf Lebovic Building, 60 Murray St, Ste 2-220, Toronto, Ontario, Canada M5T 3L9.
authors: Simon
authors: S
authors: Carette
authors: Department of Biostatistics, University of South Florida, Tampa, FL.
authors: David
authors: D
authors: Cuthbertson
authors: Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH.
authors: Gary S
authors: GS
authors: Hoffman
authors: Division of Rheumatology, University of Utah, Salt Lake City, UT.
authors: Curry L
authors: CL
authors: Koening
authors: Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH.
authors: Carol A
authors: CA
authors: Langford
authors: Division of Rheumatology, University of Pennsylvania, Philadelphia, PA.
authors: Carol
authors: C
authors: McAlear
authors: Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA.
authors: Larry
authors: L
authors: Moreland
authors: The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, MA; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA.
authors: Paul A
authors: PA
authors: Monach
authors: Division of Rheumatology, Johns Hopkins University, Baltimore, MD.
authors: Philip
authors: P
authors: Seo
authors: Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN.
authors: Ulrich
authors: U
authors: Specks
authors: Division of Rheumatology, University of Pennsylvania, Philadelphia, PA.
authors: Antoine
authors: A
authors: Sreih
authors: Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN.
authors: Steven R
authors: SR
authors: Ytterberg
authors: Division of Gastroenterology, University of Toronto-Inflammatory Bowel Disease Clinic, Toronto, Ontario, Canada.
authors: Gert
authors: G
authors: Van Assche
authors: Division of Rheumatology, University of Pennsylvania, Philadelphia, PA.
authors: Peter A
authors: PA
authors: Merkel
authors: Division of Rheumatology, Mount Sinai Hospital, University of Toronto, The Joseph and Wolf Lebovic Building, 60 Murray St, Ste 2-220, Toronto, Ontario, Canada M5T 3L9. Electronic address: cpagnoux@msn.com.
authors: Christian
authors: C
authors: Pagnoux
mesh_terms: D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008297:Male; D012189:Retrospective Studies; D014657:Vasculitis / Q000150:complications*
keywords: Crohn’s disease; Inflammatory bowel disease; Takayasu arteritis; Ulcerative colitis; Vasculitis