Early intensive therapy in Crohn's disease should be considered only in patients with disabling disease.
Dr Laurent Beaugerie and colleagues identified at diagnosis factors predictive of a subsequent 5-year disabling course.
The investigative team included 1526 patients with Crohn's disease diagnosed between 1985 and 1998.
The team excluded patients operated on within the first month of the disease, with inadequate data, and patients with severe chronic nondigestive disease.
In the 1188 remaining patients, Crohn's disease was categorized as disabling within the first 5 years when at least 1 of the criteria of clinical severity was present.
The team found that among the 1123 patients with follow-up data allowing full 5-year course classification, the rate of disabling disease was 86%.
|The rate of disabling disease at 5 years was 86%|
Independent factors present at diagnosis and significantly associated with subsequent 5-year disabling was the initial requirement for steroid use.
The investigators noted that an age below 40 years, and the presence of perianal disease were also independent predictors.
The positive predictive value of disabling disease in patients with 2 and 3 predictive factors of disabling disease was 0.91 and 0.93, respectively.
These values were 0.84 and 0.91, respectively, when tested prospectively in an independent group of 302 patients seen at the investigators' institution from 1998.
Dr Beaugerie's team concluded, “At diagnosis of Crohn's disease in a referral center, factors predictive of subsequent 5-year disabling course are an age below 40 years, the presence of perianal disease, and the initial requirement for steroids.”