(P058) DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE ASSOCIATED ERYTHEMA NODOSUM: A SYSTEMATIC REVIEW

Introduction: Inflammatory bowel disease (IBD) associated-erythema nodosum (EN) is one of the most common cutaneous manifestations of IBD, and significantly affects patients' health care related quality of life. However, despite its frequency, there is still limited data regarding diagnosis in an IBD patient population. This systematic review aimed to summarize current diagnostic approaches to IBD-EN, with the goal of facilitating the development of standardized diagnostic methods and patient-reported outcomes specific to this condition. 

Methods: A literature search was conducted in collaboration with a medical librarian. Consensus or classification criteria, case series, cross sectional and cohort studies as well as randomized controlled trials related to diagnosis of IBD-EN were included. Studies that incorporated patient data were required to meet additional inclusion criteria, including a confirmed diagnosis of IBD along with clinical or subclinical IBD-EN. 

Results: A total of 77 studies were eligible for analysis. Sixty-six studies provided prevalence data in undifferentiated subsets of IBD patients. The average prevalence of EN across the studies was 5.17% (0.2-30%) with a median of 3.45% (IQR 1.69%-7.10%). Seventy studies provided specifics regarding means of diagnosis. These included (with some overlap) use of ICD code (12), researcher review of medical records (62), physician reported diagnoses (28 in total, 13 diagnosed by gastroenterology, 15 by dermatology, and 2 in conjunction with rheumatology), and physical exam findings (10, including physical characteristics and / or location). The remaining 7 studies made no comment about methodology or specialty of provider that diagnosed EN. Due to the large heterogeneity in the available data a meta-analysis was not feasible.  

Conclusions: This systematic review reveals significant variability in the approaches to diagnosing IBD-EN in the literature. The wide range of prevalence estimates, along with inconsistent diagnostic methodologies—ranging from the use of ICD codes to diagnosis by specialists such as gastroenterologists and dermatologists—highlights the lack of standardization and evidenced based approaches to management. Until a standardized, evidence-based diagnostic and therapeutic framework is established, a multi-disciplinary approach that incorporates both clinical expertise and consistent diagnostic criteria should be prioritized to improve identification and management of IBD-EN.