Criteria for Awarding Disability Benefits to Crohn's Disease Patients: A Study of Cases in Spanish Case Law

Background: Although it is well-established which are the early and mid-term outcomes of ulcerative colitis (UC) after a first course of corticosteroids (CS), data on disease evolution of those patients responding to the first CS course are scarce.Aims: To evaluate, in UC patients responding to a first course of CS, the clinical outcome in the long-term and to identify which factors are associated to a poor outcome (steroid-dependency, steroidrefractoriness in further flares, or colectomy).Patients and Methods: UC patients (not ulcerative proctitis) who were diagnosed from January 1995 and who were followed-up in the participating centers from the first CS course because of a moderate-to-severe flare, were identified from each IBD database.Only those who responded to CS and did not start thiopurines or infliximab as maintenance therapy were included.Clinical data at disease diagnosis, at the time CS were first prescribed, and during follow-up, were recorded.Results: 100 patients were included (59 % men; mean age 35.5+/-13.4years).CS were introduced to treat a moderate (80%) or a severe attack (20%); at that moment, 51% of patients had extensive UC and 49% left-sided, and 9% were current smokers.98% of patients followed maintenance treatment after CS with mesalamine (mean dose: 2.5+/-0.7 g/d).Mean followup was 83.5+/-44.7 months.During follow-up, 7% of patients with left-sided UC had proximal spread of the disease, and 70% of patients suffered UC relapses.CS had to be reintroduced in 63% of patients (cumulative probability 37%, 61%, 65% at 1, 3, and 5 years, respectively).Immunosuppressants were introduced in 55% (cumulative probability 31%, 46%, 52% at 1, 3, and 5 years, respectively), and infliximab in 22%.Only 11% were colectomized.The cumulative probability of steroid-dependency during follow-up was 26%, 35%, and 38%, at 1, 3, and 5 years, respectively.Finally, the cumulative probability of having a steroid-refractory flare during follow-up was 9%, 17%, and 20%, respectively.Gender, age, UC extension, or severity of the first CS-treated flare, were not associated to a poorer outcome.However, time from UC diagnosis to first CS prescription was inversely associated to the development of steroid-refractoriness in further UC flares.Conclusions: Long-term outcome of UC patients responding to a first course of CS is good, with a low risk of colectomy although almost half of the patients will require immunosuppressants mainly because of steroid-dependency.