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P. Lin, H.H. Tessler, D.A. Goldstein; Family History of Inflammatory Bowel Disease in Patients with Idiopathic Ocular Inflammation . Invest. Ophthalmol. Vis. Sci. 2006;47(13):588.
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To determine the prevalence of a family history of inflammatory bowel disease (IBD) and characterize this subgroup among patients with otherwise idiopathic ocular inflammation.
Medical records of 2217 patients seen between January 1995–June 2005 at the University of Illinois Uveitis Clinic were reviewed. Patients who had a negative associated systemic disease history and work–up met our criteria for having idiopathic disease and were screened for a family history of either ulcerative colitis (UC) or Crohn's disease. We also determined the type of ocular inflammation patients with merely a family history of IBD developed compared with patients with a personal history of IBD.
We found that 727 patients out of 2217 (32.8%) met our criteria for idiopathic disease. Of these, 5.0% (36/727) had a family history of either UC or Crohn's disease. Another 16 (2.2%) reported a family history of indeterminate colitis but were excluded from subsequent calculations. Approximately two–thirds had family member(s) with UC, and one–third had family member(s) with Crohn’s disease. Accounting for the average number of first degree relatives a person has (5), the prevalence of a a family history of IBD among patients with idiopathic ocular inflammation was 3–15 fold higher than the prevalence of UC and Crohn’s in the general population (0.055–0.27%). Of patients who had a family history of either UC or Crohn's, the vast majority (over 80%) had affected first degree relatives. 36.1% (13/36) had chronic anterior uveitis, followed by acute anterior uveitis (27.8%), scleritis (13.9%), intermediate uveitis (11.1%), keratoiritis/sclerokeratitis (5.6%), posterior uveitis (2.8%), and episcleritis (2.8%). Keratoiritis/sclerokeratitis was significantly more common in patients with either a family history or a personal history of IBD than in patients without (p=0.010 and p=0.0001, respectively). Also granulomatous disease was statistically less frequent in both patients with merely a family history of IBD and in patients with a personal history of IBD (p=0.023 and p=0.005, respectively) than in patients with neither. Finally, we discovered that while 66.7% of tested patients who had a personal history of IBD were HLA–B27 positive, only 26.3% of patients with merely a family history of IBD were HLA–B27 positive.
A family history of IBD may be an independent risk factor for the development of ocular inflammation. Also, while HLA–B27 is an appropriate marker for patients with ocular inflammation and personal IBD, it may not be an appropriate marker for patients with merely a family history of IBD.
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