IgA vasculitis in patients with inflammatory bowel disease: new insights into the role of TNF-alpha blockers

Objective The association of IgA vasculitis (IgAV) and IBD is rarely described, mainly during anti-TNF-alpha therapy. We aimed to describe the association of IgAV and IBD. Methods We retrospectively analysed the association of IgAV and IBD through the implication of the GETAID and FVSG networks. Characteristics of IBD and IgAV were collected using a standardized case report form. Results Forty-three cases were included. IBD [mainly Crohn's disease (CD) in 58%] preceded IgAV in 38 (88%), with median interval of 9.2 (IQR 5.4-15.4) years. In these 38 patients, at IgAV diagnosis, five (13%) had active IBD and 28 (74%) were treated with anti-TNF-alpha for a median duration of 31.5 (IQR 19-56) months. Main IgAV manifestations were purpura all patients (100%), joints in 20/35 (57%), renal in 15/35 (43%) and gastrointestinal in 11/35 (31%) involvement. IgAV was treated with glucocorticoids in 25 (66%), colchicine in six (16%), CYC in six (16%) and anti-TNF-alpha were discontinued in 15/28 (54%). No IgAV relapse occurred when TNF-alpha blockers were stopped, vs 23% in patients pursuing it. Conversely, five (33%) had IBD flare or complication after anti-TNF-alpha cessation vs one (8%) in those continuing biologics. Anti-TNF-alpha were resumed in six (40%), with subsequent IgAV relapse in four (67%). Conclusions This large cohort suggests that TNF-alpha blockers may promote the onset of IgAV in IBD. Discontinuation of anti-TNF-alpha was associated with vasculitis remission but increased risk of IBD relapses, whereas continuation of anti-TNF-alpha was associated with IBD remission but vasculitis relapse.