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Predicting Relapse in Crohn's Disease: A Biopsychosocial Model
  1. Alain Bitton (alain.bitton{at}muhc.mcgill.ca)
  1. McGill University Health Centre, Canada
    1. Patricia Dobkin (patricia.dobkin{at}mcgill.ca)
    1. McGill University Health Centre, Canada
      1. Michael D. Edwardes (michael.edwardes{at}escorp.com)
      1. McGill University Health Centre, Canada
        1. Maida Sewitch (maida.sewitch{at}mail.mcgill.ca)
        1. McGill University Health Centre, Canada
          1. Jon Meddings (jon.meddings{at}ualberta.ca)
          1. University of Alberta, Canada
            1. Sumita Rawal (sumita.rawal{at}hotmail.com)
            1. McGill University Health Centre, Canada
              1. Albert Cohen (albert.cohen{at}gas.jgh.mcgill.ca)
              1. Jewish General Hospital, Canada
                1. Severine Vermeire (severine.vermeire{at}uz.kuleuven.ac.be)
                1. University Hospital Gasthuisberg, Belgium
                  1. Line Dufresne (line.dufresne{at}mcgill.ca)
                  1. McGill University Health Centre, Canada
                    1. Denis Franchimont (denis.franchimont{at}mcgill.ca)
                    1. McGill University Health Centre, Canada
                      1. Gary E Wild (gary.wild{at}muhc.mcgill.ca)
                      1. McGill University Health Centre, Canada

                        Abstract

                        Background: Crohn’s disease (CD) is a chronic relapsing inflammatory bowel disorder. Both biological and psychosocial factors may modulate the illness experience.

                        Aim: The aim of this study was to identify clinical, biological and psychosocial parameters as predictors of clinical relapse in quiescent CD.

                        Methods: Patients in medically-induced remission were followed prospectively for 1 year or earlier if they relapsed. Disease characteristics were determined at baseline. Serum cytokines, anti-Saccharomyces cerevisiae antibodies, C-reactive protein (CRP), erythrocyte sedimentation rate and intestinal permeability were measured every 3 months. Psychological distress, perceived stress, minor life stressors and coping strategies were measured monthly. A time-dependent multivariate Cox regression model determined predictors of time to relapse.

                        Results: 101 patients (60F, 41M) were recruited. Fourteen withdrew and 37 relapsed. CRP (Hazard ratio (HR)=1.5 per 10 mg/L, 95% confidence interval (95% CI), 1.1 to 1.9, p=0.007), fistulizing disease (HR=3.2, 95% CI, 1.1 to 9.4, p=0.04), colitis (HR=3.5 95% CI, 1.2 to 9.9, p=0.02) and the interaction between perceived stress and avoidance coping (HR=7.0 per 5 unit increase for both scales, 95% CI, 2.3 to 21.8, p=0.003) were predictors of earlier relapse.

                        Conclusions: In quiescent CD a higher CRP, fistulizing disease behavior,and disease confined to the colon were independent predictors of relapse. Moreover, patients under conditions of low stress and who scored low on avoidance coping (ie. did not engage in social diversion or distraction) were least likely to relapse. This study supports a biopsychosocial model of CD exacerbation.

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