LETTERS
TO THE
EDITOR
An Optimized Patient-reported Ulcerative Colitis Disease Activity Measure Derived from the Mayo Score and the Simple Clinical Colitis Activity Index We appreciate Dr. Walmsley’s letter and agree with the goal of patientcentered treatment algorithms and their benefits in a more personalized model of care for ulcerative colitis.1 In evaluating patient-reported symptoms, the SCCAI represents one of the better validated potential disease indices. However, as Dr. Walmsley points out and as our study further illustrates, discrepancies between patient-reported and physician-measured scores can often occur when one-on-one patient education is difficult or impossible. In these situations, the PRUCSI score offers an ideal alternative to the SCCAI and 6-point Mayo score without concern of misinformation specifically regarding the extraintestinal manifestations of ulcerative colitis. Furthermore, the inclusion of the general well-being component in the PRUCSI, which, in our study, provided comparable prediction of patient-defined remission as the SCCAI urgency component, provides superior capture of patient-reported outcomes to the 6point Mayo score. Taken together, we believe the PRUCSI adds to the armamentarium of ulcerative colitis activity assessment and provides superior disease measurement particularly in those situations where direct patient education is not feasible.
The author has no conflicts of interest to disclose. Copyright © 2014 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000256 Published online 4 December 2014.
Inflamm Bowel Dis Volume 21, Number 1, January 2015
Meenakshi Bewtra, MD, MPH, PhD*† *Department of Gastroenterology University of Pennsylvania Philadelphia, Pennsylvania † Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Philadelphia, Pennsylvania
REFERENCE 1. Walmsley RS. Comment on an Optimized Patient-reported Ulcerative Colitis Disease Activity Measure Derived from the Mayo Score and the Simple Clinical Colitis Activity Index. Inflamm Bowel Dis. 2014;20:E25–E26.
IBD and Extent of Coronary Atherosclerosis To the Editor: I read with interest the article by Aggarwal et al.1 In their article, they describe a decreased rate of severe left anterior descending and multivessel CAD among patients with IBD when compared with patients without IBD. This is in contrast to what has been found in other systemic inflammatory conditions. I believe that the data presented in the article might not be representative of the general IBD population. First, their study population had low Framingham risk scores. The mean Framingham risk score among the non-IBD group was 7.7 6 3.4 and 7.3 6 3.9 in the IBD group. This puts this population in the low-risk category and may skew the results in favor of less severe disease overall. Second, the IBD cohort had just 10 patients who were receiving biological agents. Biological agents are used in the sickest patients with IBD who are refractory to treatment with other medications.2 The low number of patients on biological agents suggests that patients in this cohort may not have severe inflammation.
The author has no conflicts of interest to disclose. Copyright © 2014 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000276 Published online 4 December 2014.
Since, inflammation is involved in the pathogenesis of CAD3; this population of patients may not represent those who are at the highest risk of coronary artery disease. Third, the proportion of patients with smoking, hypertension, diabetes mellitus type 1, and obesity were all higher in the non-IBD cohort of patients. Of them, body mass index and smoking were statistically significant, whereas diabetes mellitus 1 and hypertension were not. These factors have been associated with increased coronary vascular risk. This could have skewed the results in favor of less severe coronary involvement in the IBD group. Fourth, the proportion of patients with preexisting coronary artery bypass graft was also much higher in the non-IBD group compared with the IBD group pointing out to a much higher percentage of patients with preexisting severe coronary artery disease in the non-IBD cohort (31.9% versus 23.7%). I believe that the results of this study might be skewed because it consisted of patients with low Framingham risk score, and there were significant differences in the IBD and non-IBD cohort, which could have skewed the non-IBD cohort to develop more severe coronary artery disease. I would like to praise the authors for looking into this pertinent issue, and I hope that this study will pave the way for future studies that can better characterize the extent of coronary vascular involvement in patients with IBD.
Sudeep D. Thapa, MD Internal Medicine Henry Ford Hospital Detroit, Michigan
REFERENCES 1. Aggarwal A, Atreja A, Kapadia S, et al. Conventional risk factors and cardiovascular outcomes of patients with inflammatory bowel disease with confirmed coronary artery disease. Inflamm Bowel Dis. 2014;20:1593–1601. 2. Nielsen OH, Ainsworth MA. Tumor necrosis factor inhibitors for inflammatory bowel disease. N Engl J Med. 2013;369:754–762. 3. Christodoulidis G, Vittorio TJ, Fudim M, et al. Inflammation in coronary artery disease. Cardiol Rev. 2014;22:279–288.
www.ibdjournal.org |
E1
TO THE
EDITOR
An Optimized Patient-reported Ulcerative Colitis Disease Activity Measure Derived from the Mayo Score and the Simple Clinical Colitis Activity Index We appreciate Dr. Walmsley’s letter and agree with the goal of patientcentered treatment algorithms and their benefits in a more personalized model of care for ulcerative colitis.1 In evaluating patient-reported symptoms, the SCCAI represents one of the better validated potential disease indices. However, as Dr. Walmsley points out and as our study further illustrates, discrepancies between patient-reported and physician-measured scores can often occur when one-on-one patient education is difficult or impossible. In these situations, the PRUCSI score offers an ideal alternative to the SCCAI and 6-point Mayo score without concern of misinformation specifically regarding the extraintestinal manifestations of ulcerative colitis. Furthermore, the inclusion of the general well-being component in the PRUCSI, which, in our study, provided comparable prediction of patient-defined remission as the SCCAI urgency component, provides superior capture of patient-reported outcomes to the 6point Mayo score. Taken together, we believe the PRUCSI adds to the armamentarium of ulcerative colitis activity assessment and provides superior disease measurement particularly in those situations where direct patient education is not feasible.
The author has no conflicts of interest to disclose. Copyright © 2014 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000256 Published online 4 December 2014.
Inflamm Bowel Dis Volume 21, Number 1, January 2015
Meenakshi Bewtra, MD, MPH, PhD*† *Department of Gastroenterology University of Pennsylvania Philadelphia, Pennsylvania † Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Philadelphia, Pennsylvania
REFERENCE 1. Walmsley RS. Comment on an Optimized Patient-reported Ulcerative Colitis Disease Activity Measure Derived from the Mayo Score and the Simple Clinical Colitis Activity Index. Inflamm Bowel Dis. 2014;20:E25–E26.
IBD and Extent of Coronary Atherosclerosis To the Editor: I read with interest the article by Aggarwal et al.1 In their article, they describe a decreased rate of severe left anterior descending and multivessel CAD among patients with IBD when compared with patients without IBD. This is in contrast to what has been found in other systemic inflammatory conditions. I believe that the data presented in the article might not be representative of the general IBD population. First, their study population had low Framingham risk scores. The mean Framingham risk score among the non-IBD group was 7.7 6 3.4 and 7.3 6 3.9 in the IBD group. This puts this population in the low-risk category and may skew the results in favor of less severe disease overall. Second, the IBD cohort had just 10 patients who were receiving biological agents. Biological agents are used in the sickest patients with IBD who are refractory to treatment with other medications.2 The low number of patients on biological agents suggests that patients in this cohort may not have severe inflammation.
The author has no conflicts of interest to disclose. Copyright © 2014 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000276 Published online 4 December 2014.
Since, inflammation is involved in the pathogenesis of CAD3; this population of patients may not represent those who are at the highest risk of coronary artery disease. Third, the proportion of patients with smoking, hypertension, diabetes mellitus type 1, and obesity were all higher in the non-IBD cohort of patients. Of them, body mass index and smoking were statistically significant, whereas diabetes mellitus 1 and hypertension were not. These factors have been associated with increased coronary vascular risk. This could have skewed the results in favor of less severe coronary involvement in the IBD group. Fourth, the proportion of patients with preexisting coronary artery bypass graft was also much higher in the non-IBD group compared with the IBD group pointing out to a much higher percentage of patients with preexisting severe coronary artery disease in the non-IBD cohort (31.9% versus 23.7%). I believe that the results of this study might be skewed because it consisted of patients with low Framingham risk score, and there were significant differences in the IBD and non-IBD cohort, which could have skewed the non-IBD cohort to develop more severe coronary artery disease. I would like to praise the authors for looking into this pertinent issue, and I hope that this study will pave the way for future studies that can better characterize the extent of coronary vascular involvement in patients with IBD.
Sudeep D. Thapa, MD Internal Medicine Henry Ford Hospital Detroit, Michigan
REFERENCES 1. Aggarwal A, Atreja A, Kapadia S, et al. Conventional risk factors and cardiovascular outcomes of patients with inflammatory bowel disease with confirmed coronary artery disease. Inflamm Bowel Dis. 2014;20:1593–1601. 2. Nielsen OH, Ainsworth MA. Tumor necrosis factor inhibitors for inflammatory bowel disease. N Engl J Med. 2013;369:754–762. 3. Christodoulidis G, Vittorio TJ, Fudim M, et al. Inflammation in coronary artery disease. Cardiol Rev. 2014;22:279–288.
www.ibdjournal.org |
E1
