Investigating the Association Between Hidradenitis Suppurativa and Inflammatory Bowel Disease: A Real-World Comparison Study of Crohn’s Disease and Ulcerative Colitis
Background:
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition often associated with inflammatory bowel disease (IBD), particularly Crohn’s disease (CD) and ulcerative colitis (UC). This study explores the prevalence, incidence, and clinical outcomes of HS in patients with IBD using real-world data from the TriNetX database. Understanding the relationship between HS and these IBD subtypes can inform treatment strategies and improve understanding of shared pathophysiological mechanisms.
Methods:
A retrospective cohort study was conducted using the TriNetX database, examining data from patients diagnosed with HS, CD, and UC between 2004 and 2024. Prevalence and incidence rates of HS were calculated in patients with IBD, with separate analysis for CD and UC groups. Additionally, demographic factors, comorbidities, and clinical outcomes were analyzed. Chi-square tests and logistic regression identified significant associations and independent risk factors. A propensity-matched analysis compared IBD patients with and without HS to assess differences in clinical outcomes such as colectomy, bowel obstruction, and intestinal perforation.
Results:
Among 205,386 patients with IBD, the overall prevalence of HS was 2.99%, with a higher prevalence in males (3.48%) compared to females (2.78%). HS was most common among the white race (3.6%), followed by Native Hawaiian or Pacific Islanders (3.32%). The prevalence of HS was higher in patients with CD (2.14%) compared to patients with UC (1.38%). The incidence rate of HS in CD patients was 5.71 cases per person-day. In a propensity-matched analysis, no significant difference in colectomy rates was found between IBD patients with and without HS (<italic>P-</italic>value 0.35; OR 1.07; 95% CI 0.920, 1.262). However, a significantly higher rate of bowel obstruction was observed in IBD patients with HS (<italic>P-</italic>value 0.01; OR 1.728; 95% CI 1.630, 1.833). The risk of intestinal perforation did not differ significantly between the 2 groups (<italic>P-</italic>value 0.49; OR 1.09; 95% CI 0.846, 1.417). HS was associated with more severe disease activity in both CD and UC patients, with the association being stronger in CD patients. Further analysis of propensity-matched cohorts, UC + HS and CD + HS, revealed that mortality rates were higher in UC patients than in CD patients (<italic>P-</italic>value 0.007; OR 1.406; 95% CI 1.094, 1.807). No difference in all-cause hospitalization rates was observed. Complications were more frequent in CD + HS patients than UC + HS patients, including higher rates of colectomy (<italic>P-</italic>value 0.016; OR 0.597; 95% CI 0.389, 0.917), fistula (<italic>P-</italic>value 0.001; OR 0.159; 95% CI 0.118, 0.214), stricture/obstruction (<italic>P-</italic>value 0.001; OR 0.393; 95% CI 0.289, 0.536), abscess (<italic>P-</italic>value 0.001; OR 0.266; 95% CI 0.195, 0.362), and ulcers (<italic>P-</italic>value 0.000; OR 0.475; 95% CI 0.344, 0.654).
Conclusions:
This study highlights an increased prevalence of HS in patients with IBD, particularly in those with Crohn’s disease, and a higher risk of bowel obstruction in patients with both conditions. HS may indicate more severe disease activity in IBD, especially in Crohn’s disease, warranting further research to explore shared inflammatory mechanisms and optimize treatment.
