Prevalence and Association of Restless Leg Syndrome, Depression and Anxiety in Patients With Inflammatory Bowel Disease

Introduction: Inflammatory bowel disease (IBD) is associated with many extraintestinal manifestations. Restless leg syndrome (RLS) is considered to be one of the neurological manifestations seen in IBD. There is limited data available regarding the RLS in the setting of IBD. We aimed to evaluate the prevalence of RLS, as well as concurrent anxiety and depression in patients with IBD. Methods: Patients having IBD were prospectively enrolled in the study from years 2017-2020 at outpatient clinics of our institution. Patients were screened for RLS, depression and anxiety. The severity of RLS was determined by using the international RLS study group rating scale. Beck depression and anxiety inventories were used to evaluate the severity of depression and anxiety. Patients with iron deficiency anemia and those are on anxiolytic and antidepressant medications were excluded. Laboratory and clinical data were obtained. All patients provided informed consent. Results: A total of 194 patients were included in the study (102 male, 92 female; mean age: 42.3 ±13.5). Of those, 76 (39.2%) had ulcerative colitis (UC) and 118 (60.8%) had Crohn’s disease (CD). IBD was present for a mean of 10.19 ±6.4 years at the time of the enrollment. In patients with CD, 46.3% had fistulizing CD, 41.6% had history of surgical operation and 33% had perianal involvement. Ninety-one (46.9%) patients with IBD were found to have RLS. Of those, 54 (45.8%) had CD and 37 (59.3%) had UC. Of 91 patients with RLS, 59 (64.8%) were female and 32 (35.2%) were male (p< 0.001). Hundred and eighty-seven patients were screened for depression, 58 (31%) patients had depression. Of those with depression, 37 (63.9%) were female and 21 (36.2%) were male (p=0.004). Hundred and fifty-six patients had anxiety, 92 (59%) were male and 64 (41%) were female (p< 0.001). The severity of anxiety was classified as mild, moderate and severe. In males, the severity was mild in 92.9%, moderate 7.1% and severe 0%, in females 71.9%, 24.7% and 3.4% of patients, respectively.Mean scores for RLS severity rating, Beck depression and anxiety inventory scores were shown in Table 1. Patients with CD with perianal involvement were more likely to have depression (46.9% vs 23.4%, p=0.034). Conclusion: RLS, depression and anxiety were found to be a common comorbid conditions in patients with IBD. Perianal involvement in CD should alert for the presence of depression. Screening for those conditions is important in implementing the treatment timely and to improve the quality of life.Table 1.: Clinical and laboratory characteristics of study patients (n=194).