title: Inflammatory Bowel Disease in Juvenile Idiopathic Arthritis Patients Treated with Biologics.
abstract: OBJECTIVE
  Evolving inflammatory bowel disease (IBD) is a matter of interest in patients with juvenile idiopathic arthritis (JIA) and might be associated with JIA therapy.
  
  
  METHODS
  Data from the German biologics registry (Biologika in der Kinderrheumatologie; BiKeR) from 2001 to 2013 were analyzed.
  
  
  RESULTS
  There were 3071 patients with 8389 patient-years (PY) of observation followed. IBD was diagnosed in 11 patients, 8 with Crohn disease and 3 with ulcerative colitis. IBD incidence in patients with JIA was 1.31/1000 PY and higher than published IBD incidences in pediatric populations. Compared with the total BiKeR cohort, patients with IBD more commonly had enthesitis-related arthritis, extended oligoarthritis, psoriatic arthritis, and also rheumatoid factor (RF)-negative polyarthritis. No IBD occurred in patients with systemic JIA or RF-positive polyarthritis. In patients treated with methotrexate (MTX), the IBD incidence was significantly lower compared with patients not treated with MTX. Etanercept (ETN) monotherapy, but not the combination of ETN and MTX, was associated with an increased incidence of IBD.
  
  
  CONCLUSIONS
  Incidence of IBD in patients with JIA is higher than in the population. MTX turned out to be protective, even in combination with ETN.
authors.affiliation: From the Department of Pediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin; Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst; Asklepios Rheumazentrum Hamburg, Hamburg; Pediatric Practice, Lueneburg; Deutsches Rheuma-Forschungszentrum, Berlin; Department of Pediatrics, Vivantes Klinikum im Friedrichshain, Berlin; Department of Pediatrics, Klinikum Stuttgart, Stuttgart, Germany.D. Barthel, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin; G. Ganser, MD, Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst; R.M. Kuester, MD, Senior Consultant, Asklepios Rheumazentrum Hamburg; N. Onken, MD, Pediatric Practice; K. Minden, MD, Deutsches Rheuma-Forschungszentrum; H.J. Girschick, MD, Department of Pediatrics, Vivantes Klinikum im Friedrichshain; A. Hospach, MD, Department of Pediatrics, Klinikum Stuttgart; G. Horneff, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin. d.barthel@asklepios.com.
authors.forename: Deborah
authors.initials: D
authors.lastname: Barthel
authors.affiliation: From the Department of Pediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin; Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst; Asklepios Rheumazentrum Hamburg, Hamburg; Pediatric Practice, Lueneburg; Deutsches Rheuma-Forschungszentrum, Berlin; Department of Pediatrics, Vivantes Klinikum im Friedrichshain, Berlin; Department of Pediatrics, Klinikum Stuttgart, Stuttgart, Germany.D. Barthel, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin; G. Ganser, MD, Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst; R.M. Kuester, MD, Senior Consultant, Asklepios Rheumazentrum Hamburg; N. Onken, MD, Pediatric Practice; K. Minden, MD, Deutsches Rheuma-Forschungszentrum; H.J. Girschick, MD, Department of Pediatrics, Vivantes Klinikum im Friedrichshain; A. Hospach, MD, Department of Pediatrics, Klinikum Stuttgart; G. Horneff, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin.
authors.forename: Gerd
authors.initials: G
authors.lastname: Ganser
authors.affiliation: From the Department of Pediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin; Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst; Asklepios Rheumazentrum Hamburg, Hamburg; Pediatric Practice, Lueneburg; Deutsches Rheuma-Forschungszentrum, Berlin; Department of Pediatrics, Vivantes Klinikum im Friedrichshain, Berlin; Department of Pediatrics, Klinikum Stuttgart, Stuttgart, Germany.D. Barthel, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin; G. Ganser, MD, Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst; R.M. Kuester, MD, Senior Consultant, Asklepios Rheumazentrum Hamburg; N. Onken, MD, Pediatric Practice; K. Minden, MD, Deutsches Rheuma-Forschungszentrum; H.J. Girschick, MD, Department of Pediatrics, Vivantes Klinikum im Friedrichshain; A. Hospach, MD, Department of Pediatrics, Klinikum Stuttgart; G. Horneff, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin.
authors.forename: Rolf-Michael
authors.initials: RM
authors.lastname: Kuester
authors.affiliation: From the Department of Pediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin; Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst; Asklepios Rheumazentrum Hamburg, Hamburg; Pediatric Practice, Lueneburg; Deutsches Rheuma-Forschungszentrum, Berlin; Department of Pediatrics, Vivantes Klinikum im Friedrichshain, Berlin; Department of Pediatrics, Klinikum Stuttgart, Stuttgart, Germany.D. Barthel, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin; G. Ganser, MD, Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst; R.M. Kuester, MD, Senior Consultant, Asklepios Rheumazentrum Hamburg; N. Onken, MD, Pediatric Practice; K. Minden, MD, Deutsches Rheuma-Forschungszentrum; H.J. Girschick, MD, Department of Pediatrics, Vivantes Klinikum im Friedrichshain; A. Hospach, MD, Department of Pediatrics, Klinikum Stuttgart; G. Horneff, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin.
authors.forename: Nils
authors.initials: N
authors.lastname: Onken
authors.affiliation: From the Department of Pediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin; Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst; Asklepios Rheumazentrum Hamburg, Hamburg; Pediatric Practice, Lueneburg; Deutsches Rheuma-Forschungszentrum, Berlin; Department of Pediatrics, Vivantes Klinikum im Friedrichshain, Berlin; Department of Pediatrics, Klinikum Stuttgart, Stuttgart, Germany.D. Barthel, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin; G. Ganser, MD, Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst; R.M. Kuester, MD, Senior Consultant, Asklepios Rheumazentrum Hamburg; N. Onken, MD, Pediatric Practice; K. Minden, MD, Deutsches Rheuma-Forschungszentrum; H.J. Girschick, MD, Department of Pediatrics, Vivantes Klinikum im Friedrichshain; A. Hospach, MD, Department of Pediatrics, Klinikum Stuttgart; G. Horneff, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Minden
authors.affiliation: From the Department of Pediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin; Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst; Asklepios Rheumazentrum Hamburg, Hamburg; Pediatric Practice, Lueneburg; Deutsches Rheuma-Forschungszentrum, Berlin; Department of Pediatrics, Vivantes Klinikum im Friedrichshain, Berlin; Department of Pediatrics, Klinikum Stuttgart, Stuttgart, Germany.D. Barthel, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin; G. Ganser, MD, Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst; R.M. Kuester, MD, Senior Consultant, Asklepios Rheumazentrum Hamburg; N. Onken, MD, Pediatric Practice; K. Minden, MD, Deutsches Rheuma-Forschungszentrum; H.J. Girschick, MD, Department of Pediatrics, Vivantes Klinikum im Friedrichshain; A. Hospach, MD, Department of Pediatrics, Klinikum Stuttgart; G. Horneff, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin.
authors.forename: Hermann Josef
authors.initials: HJ
authors.lastname: Girschick
authors.affiliation: From the Department of Pediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin; Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst; Asklepios Rheumazentrum Hamburg, Hamburg; Pediatric Practice, Lueneburg; Deutsches Rheuma-Forschungszentrum, Berlin; Department of Pediatrics, Vivantes Klinikum im Friedrichshain, Berlin; Department of Pediatrics, Klinikum Stuttgart, Stuttgart, Germany.D. Barthel, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin; G. Ganser, MD, Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst; R.M. Kuester, MD, Senior Consultant, Asklepios Rheumazentrum Hamburg; N. Onken, MD, Pediatric Practice; K. Minden, MD, Deutsches Rheuma-Forschungszentrum; H.J. Girschick, MD, Department of Pediatrics, Vivantes Klinikum im Friedrichshain; A. Hospach, MD, Department of Pediatrics, Klinikum Stuttgart; G. Horneff, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin.
authors.forename: Anton
authors.initials: A
authors.lastname: Hospach
authors.affiliation: From the Department of Pediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin; Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst; Asklepios Rheumazentrum Hamburg, Hamburg; Pediatric Practice, Lueneburg; Deutsches Rheuma-Forschungszentrum, Berlin; Department of Pediatrics, Vivantes Klinikum im Friedrichshain, Berlin; Department of Pediatrics, Klinikum Stuttgart, Stuttgart, Germany.D. Barthel, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin; G. Ganser, MD, Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst; R.M. Kuester, MD, Senior Consultant, Asklepios Rheumazentrum Hamburg; N. Onken, MD, Pediatric Practice; K. Minden, MD, Deutsches Rheuma-Forschungszentrum; H.J. Girschick, MD, Department of Pediatrics, Vivantes Klinikum im Friedrichshain; A. Hospach, MD, Department of Pediatrics, Klinikum Stuttgart; G. Horneff, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin.
authors.forename: Gerd
authors.initials: G
authors.lastname: Horneff
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D000068800:Etanercept / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution
chemical_list: D001688:Biological Products; D000068800:Etanercept; D008727:Methotrexate
keywords: BIOLOGICS; ETANERCEPT; INFLAMMATORY BOWEL DISEASE; JUVENILE IDIOPATHIC ARTHRITIS; METHOTREXATE