Document Type

Conference Proceeding

Publication Date

5-2-2025

Abstract

Background/Objective Inflammatory bowel disease (IBD) is an autoimmune disorder that can present with a wide range of clinical manifestations spanning multiple organ systems. Myositis in patients diagnosed with IBD is an uncommon presentation, and the pathophysiology in this population is not well studied. Given the lack of research surrounding the natural history of myositis in IBD patients, we decided to investigate the demographics and medication use that may potentially serve as predictors of symptom development. We hypothesized increased rates of myositis development in patients on TNF-alpha inhibitors given anecdotal evidence in clinical practice and literature review of several clinical vignettes that suggest a potential relationship. Methods This is a retrospective study using data from the electronic medical database of a large hospital system. The sample included adults and children diagnosed with IBD, who were divided into groups of myositis, no myositis, and unable to confirm, with the latter excluded from further analysis. Designation of myositis was a complex process including combinations of ICD 9 and 10 codes with presence of largely elevated creatine kinase (CK) and absence of CK-MB. Our variables of interest included demographic information and medication history including aminosalicylates, TNF-inhibitors, immunomodulators, integrin receptor antagonists, interleukin inhibitors (targeting IL-1, IL-4, IL-5, IL-6, IL-12, IL-13, IL-17A, IL-23A), and steroids. Adjusted odds ratios for diagnosis of myositis were calculated using logistic regressions, using our variables of interest. Results Our study included 26,040 patients, divided into 117 in the myositis group, 24802 in the no myositis group, and 1121 in the unable to confirm group. Demographics analysis was significant for increased myositis rates in female patients. Aminosalicylate use was an independent predictor against myositis diagnosis (Adjusted OR 0.62, p 0.023), and steroid use was an independent predictor for myositis diagnosis in our IBD population (Adjusted OR 2.86, p< 0.001). There were no significant associations with myositis presentation seen for the other classes of medications. Discussion/Conclusion Contrary to several anecdotal evidence, our analysis reports no association between taking TNF-inhibitors, immunomodulators, integrin receptor antagonists, or interleukin inhibitors, and developing myositis. However, the myositis incidence was statistically lower in the aminosalicylate group and higher in the steroid group. There was also evidence of interaction between immunomodulators and age, sex, and steroid use which results in increased reports of myositis. Further research is needed to investigate a wider range of risk factors, and consideration must be given for a possible common pathophysiological background between IBD and myositis. The difficulties faced in classifying myositis in our study also points to a need for standardization of myositis diagnosis.

Comments

American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter Resident and Medical Student Day, May 2, 2025, Troy, MI

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