Microscopic Colitis and Risk of Incident Psoriasis: A Nationwide Population-Based Matched Cohort Study

David Bergman; Bjorn Roelstraete; Jiangwei Sun; Fahim Ebrahimi; Rickard Lidström; Axel Svedbom; Mona Ståhle; Jonas F Ludvigsson

doi:10.2147/CLEP.S454677

Microscopic Colitis and Risk of Incident Psoriasis: A Nationwide Population-Based Matched Cohort Study

Clin Epidemiol. 2024 Mar 29:16:213-225. doi: 10.2147/CLEP.S454677. eCollection 2024.

Authors

David Bergman¹, Bjorn Roelstraete¹, Jiangwei Sun¹, Fahim Ebrahimi^{1

2}, Rickard Lidström³, Axel Svedbom^{4

5}, Mona Ståhle⁴, Jonas F Ludvigsson^{1

6

7}

Affiliations

¹ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
² Department of Gastroenterology and Hepatology, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland.
³ Diagnostiskt Centrum Hud, Stockholm, Sweden.
⁴ Division of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
⁵ Dermatology and Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden.
⁶ Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.
⁷ Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.

Abstract

Background: Microscopic colitis (MC) has been associated with several immune-mediated diseases including psoriasis, but earlier research has been limited to psoriasis occurring before MC. Data from large-scale cohort studies investigating MC and risk of future psoriasis are lacking.

Objective: To examine the association between MC and psoriasis.

Methods: In a nationwide, population-based, matched cohort study in Sweden from 2007 to 2021, we identified 8404 patients with biopsy-verified MC (diagnosed in 2007-2017), 37,033 matched reference individuals, and 8381 siblings without MC. Information on MC was obtained through the ESPRESSO cohort (a Swedish histopathology database with nationwide coverage). Using Cox regression, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for psoriasis up until 2021.

Results: During a median follow-up of 9.2 years (interquartile range = 6.7-11.7), 179 MC patients and 440 reference individuals were diagnosed with psoriasis (241.1 vs 131.8 events per 100,000 person-years), corresponding to one extra case of psoriasis in 91 patients with MC over 10 years. After adjustment for the matching variables (birth year, sex, county of residence, and calendar period) and level of education, we computed an adjusted hazard ratio (aHR) of 1.82 (95% CI = 1.53-2.17). Stratified by sex, estimates were similar and when examining the aHR across different lengths of follow-up, we found significantly elevated estimates up to 10 years after MC diagnosis. Compared to MC-free siblings, the aHR was 1.85 (95% CI = 1.36-2.51).

Conclusion: Patients with MC are at an almost doubled risk of psoriasis compared to the general population. Clinicians need to consider psoriasis in MC patients with skin lesions.

Keywords: epidemiology; microscopic colitis; psoriasis.

Grants and funding

This work was supported by the Karolinska Institutet (Ludvigsson), Stockholm County Council (Ludvigsson), the NIH (National Institutes of Health NIA R01 (AG068390; Ludvigsson)). None of the funding organizations has had any role in the design and conduct of the study, in the collection, management, and analysis of the data, or in the preparation, review, and approval of the manuscript.