한빛사 논문
Choong‑Kyun Noh1†, Eunyoung Lee2,3,4†, Bumhee Park3,4* and Sung Soo Ahn5*
1Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea. 2Department of Medical Sciences, Biomedical Informatics, Graduate School of Ajou University, Suwon, Republic of Korea. 3Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Repub‑lic of Korea. 4Ofce of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea. 5Division of Rheumatology, Department of Internal Medicine, Yongin Severance Hospi‑tal, Yonsei University College of Medicine, Yongin, Republic of Korea.
†Choong-Kyun Noh and Eunyoung Lee contributed equally to this work.
*Correspondence
Abstract
Background
Accumulating evidence now indicates that the presence of faecal haemoglobin, in the absence of gastrointestinal bleeding, may be an indicator of systemic inflammation and is linked to the development of human diseases. We evaluated whether a positive faecal immunochemical test (FIT) is associated with the development of immune-mediated inflammatory diseases (IMIDs).
Methods
Data from the nationwide colorectal cancer screening programme from 2009 to 2013 were used. Participants (n=8,646,887) were divided into FIT (+) and FIT (-) groups by performing a 1:1 random sampling matched by age and sex. Participants with concurrent haemorrhoids, colorectal cancer (CRC), inflammatory bowel disease (IBD), and missed CRC and IBD were excluded using the colonoscopy results, ICD-10 codes, and the special exemption code (V code). Endpoints were the incidence of IMIDs (rheumatoid arthritis [RA], systemic lupus erythematosus [SLE], and psoriatic arthritis [PsA]) after FIT.
Results
Of the 1,044,955 eligible participants, 229,594 and 815,361 individuals were included in the FIT (+) and the FIT (−) groups, respectively. During the mean follow-up period of 7.59 years, a total of 7645 (incidence rate [IR] 9.56/10,000 person-years [PY]), 208 (IR 0.26/10,000 PY), and 101 (IR 0.13/10,000 PY) patients were diagnosed with RA, SLE, and PsA, respectively. An adjusted Cox analysis demonstrated that FIT positivity conferred a 1.16 (95% confidence interval [CI] 1.09–1.24, p<0.001) times greater risk of developing RA. Kaplan–Meier analysis in the 1:2 propensity-score matched population also confirmed these results (hazard ratio [HR] 1.18, 95% CI 1.10–1.27, p<0.001).
Conclusions
Positive FIT is associated with increased risk of RA in the general population, corroborating that aberrancies of gut mucosa are associated with the development of IMIDs. Vigilant monitoring and early referral to a specialist upon medical suspicion is required in this population.
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