OBJECTIVE: To describe risk factors for IBD development in a cohort of children with JIA. METHODS: JIA patients who developed IBD were identified from the international Pharmachild register. Characteristics were compared between IBD and non-IBD patients and predictors of IBD were determined using multivariable logistic regression analysis. Incidence rates of IBD events on different DMARDs were calculated, and differences between therapies were expressed as relative risks (RR). RESULTS: Out of 8942 patients, 48 (0.54% ) developed IBD. These were more often male (47.9% vs 32.0%) and HLA-B27 positive (38.2% vs 21.0%) and older at JIA onset (median 8.94 vs 5.33 years) than patients without IBD development. They also had more often a family history of autoimmune disease (42.6% vs 24.4%) and enthesitis-related arthritis (39.6% vs 10.8%). The strongest predictors of IBD on multivariable analysis were enthesitis-related arthritis [odds ratio (OR): 3.68, 95% CI: 1.41, 9.40] and a family history of autoimmune disease (OR: 2.27, 95% CI: 1.12, 4.54). Compared with methotrexate monotherapy, the incidence of IBD on etanercept monotherapy (RR: 7.69, 95% CI: 1.99, 29.74), etanercept with methotrexate (RR: 5.70, 95% CI: 1.42, 22.77) and infliximab (RR: 7.61, 95% CI: 1.27, 45.57) therapy was significantly higher. Incidence on adalimumab was not significantly different (RR: 1.45, 95% CI: 0.15, 13.89). CONCLUSION: IBD in JIA was associated with enthesitis-related arthritis and a family history of autoimmune disease. An increased IBD incidence was observed for etanercept therapy regardless of concomitant methotrexate use.

2nd Department of Pediatrics Athens Medical School National and Kapodistrian University of Athens Athens Greece

Children's Hospital Affiliate of Vilnius University Hospital Santaros Clinic

Clinic of Children's Diseases Vilnius University Vilnius Lithuania

Clinica Pediatrica e Reumatologia IRCCS Istituto Giannina Gaslini

Departamento de Pediatria Facultad de Medicina Hospital Universitario Dr J E González Universidad Autónoma de Nuevo León Monterrey NL Mexico

Department of Clinical and Molecular Medicine Faculty of Medicine and Health Sciences NTNU Norwegian University of Science and Technology

Department of Clinical Medicine UiT the Arctic University of Norway Tromso Norway

Department of Medical Physics Alexandru Ioan Cuza University of Iasi Iasi Romania

Department of Paediatrics University of Zagreb School of Medicine Zagreb Croatia

Department of Pediatric Immunology and Rheumatology Wilhelmina Children's Hospital Utrecht The Netherlands

Department of Pediatrics and Inherited Metabolic Disorders 1st Faculty of Medicine and General University Hospital Charles University Prague Prague Czech Republic

Department of Pediatrics St Olavs University Hospital of Trondheim Trondheim Norway

Department of Pediatrics University Hospital of North Norway

Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno Infantili Università degli Studi di Genova Genoa Italy

Division of Pediatric Rheumatology Institute of Rheumatology of Belgrade Belgrade Serbia

Instituto de Puericultura e Pediatria Martagao Gesteira Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil

Pediatric Rheumatology Unit São Paulo State University Botucatu Brasil

Sir Ganga Ram Hospital Marg Centre for Child Health Sir Ganga Ram Hospital New Delhi India

Unit of Pediatric Rheumatology Immunology 2nd Department of Pediatrics Semmelweis University Budapest Hungary

Unit of Rheumatology Adolescent Health Studies Center Rio de Janeiro State University Rio de Janeiro Brazil

Unita' di Immunologia e Reumatologia Pediatrica Clinica Pediatrica dell'Universita' di Brescia Spedali Civili Brescia Italy

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