Background: Crohn's disease (CD) can lead to progressive bowel damage and disability. Disability has been proposed by the SPIRIT-IOIBD consensus as an endpoint in disease-modification trials. Despite this, there is scarce data on disability at CD diagnosis.
Methods: The Crohn's Disease Cohort (CROCO) is an ongoing prospective cohort study with newly diagnosed CD patients (within 12 months of diagnosis) aiming to assess the evolution of bowel damage and disability over time. Disability evaluation was conducted via the validated IBD-Disability Index (IBD-DI), which encompasses 14 questions ranging from 0-100 intended to measure overall health, sleep and energy, affect, body image, pain, regulating defecation, interpersonal activities, and work and education.¹ This study explored disability scores (DS) and their association with disease features and activity at diagnosis in patients with newly diagnosed CD. The IBD-DI was categorized as previously reported: no disability (scores 0-20), mild disability (scores 21-35), moderate-severe (scores 36-100).²
Results: From a cohort of 261 patients [58% male, median age at diagnosis of 35yo (IQR 25-49)], 224 completed the IBD-DI at inclusion. Median time from inclusion to baseline visit was 4 months (IQR 1.7;7.8). Most patients presented with ileal or ileocolonic disease location (87%) and an inflammatory phenotype (69%); 16% had perianal disease and 27% extraintestinal manifestations. At inclusion, 21% had been hospitalised, and 10% had a CD-related surgery. Treatments included steroids (56%), immunosuppressants (34%), and anti-TNF therapy (40%). The median DS at inclusion was 22.2 (IQR 10.4-37.9), with 48% exhibiting no disability and 30% displaying moderate-severe disability (Figure 1). Moderate-severe disability at baseline visit was associated with female gender (OR 3.65, 95%CI 2.01-6.62, p<0.01), stricturing behavior (OR 2.34, 95%CI 1.1-4.98), Harvey-Bradshaw Index (OR 1.36, 95%CI 1.23-1.5, p<0.01), extraintestinal manifestations (OR 2.61, 95%CI 1.41-4.84, p<0.002), and steroid use (OR 1.89, 95%CI 1.04-3.45, p=0.034). No significant associations were found with age, smoking, or biomarkers (Table 1).
Conclusion: One-third of newly diagnosed CD patients have moderate-severe disability. Disability was associated with female gender, disease phenotype, clinical severity, extraintestinal manifestations, and steroid usage. Disability is an important feature of newly diagnosed CD and may characterize a unique group of patients at diagnosis.

References
PMID: 26646934
PMID: 27516406

<b>Figure 1 – </b>Characterization of the IBD-DI at baseline visit (recruitment into the study: <12 months after diagnosis) in a cohort of newly diagnosed CD patients.

Figure 1 – Characterization of the IBD-DI at baseline visit (recruitment into the study: <12 months after diagnosis) in a cohort of newly diagnosed CD patients.

<b>Table 1 - </b>Association between disability scores (no or mild disability versus moderate or severe disability) and disease features and activity at baseline visit (recruitment into the study: <12 months after diagnosis).

Table 1 - Association between disability scores (no or mild disability versus moderate or severe disability) and disease features and activity at baseline visit (recruitment into the study: <12 months after diagnosis).

Jérôme Lambert

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