Summary
Gastrointestinal inflammation or infection can be associated with various forms of arthritis, such as, acute reactive arthritis triggered by enteritis due to gram-negative bacteria or ankylosing spondylitis and peripheral arthritis in relation to Crohn's disease and ulcerative colitis. Using colonoscopy, we have found a high prevalence of clinically silent inflammatory lesions in 38 patients (24 males and 14 females) affected by undifferentiated spondyloarthropathies (SpA). Microscopic inflammatory lesions were present in all the patients. Three patterns of nonspecific chronic inflammatory alterations were observed. No difference was noted between patients taking or not taking nonsteroidal anti-inflammatory drugs. Direct immunofluorescence demonstrated the presence of IgG, IgA, IgM, C3, C4 and fibrinogen in 75% of the specimens examined. The finding of chronic inflammatory gut lesions hypothesizes that a local activation of the immune system depending on the persistence of intestinal microbial antigens or toxins, due to impaired elimination or increased exposition, may have a part in the pathogenesis of SpA.
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References
Haslock, I., Wright, V. The musculo-skeletal complications of Crohn's disease. Medicine 1973, 52, 217–224.
Adrian, J., Greenstein, A.J., Henry, D., Janowitz, M.D., Sachar, M.D. The extra-intestinal complications of Crohn's disease and ulcerative colitis: a study of 700 patients. Medicine 1976, 55, 407–412.
Dekker-Saeys, B.J., Meuwissen, S.G.M., Van der Berg-Loonen, E.M., De Haas, W.H., Agenant, D., Tytgate, G.N. Prevalence of peripheral arthritis, sacroilitis and ankylosing spondylitis in patients suffering from inflammatory bowel disease. Ann Rheum Dis 1978, 37, 33–35.
Aho, K., Leirisalo-Repo, M., Repo, M. Reactive arthritis. Clin Rheum Dis 1985, 11, 25–40.
Clarke, J., Weiner, S.R., Basset, L.W., Utsinger, P.D. Bypass disease. Clin Exp Rheum 1987, 5, 275–287.
Mielants, H., Veys, E.M., Cuvelier, C., De Vos, M., Joos, R. Ileocolonoscopic findings in seronegative spondyloarthropathies. Brit J Rheumatol 1988, 27, 95–105.
Mielants, H., Veys, E.M., Goethals, K., Van Der Straeten, C., Ackerman, C. Destructive lesions of small joints in seronegative spondyloarthropathies; relation to gut inflammation. Clin Exp Rheum 1990, 8, 23–27.
Wright, V. Seronegative polyarthritis. A unified concept. Arthritis Rheum 1978, 21, 619–626.
Zeidler, H., Mau, W., Asim Khan, M. Undifferentiated Spondyloarthropathies. Rheum Dis Clin North Am 1992, 18, 187–202.
Dougados, M., Van Der Linden, F., Julin, R., Huitfeldt, B., Amor, B., Calin, A., Cats, A., Dijkhans, B., Olivieri, I., Pasero, G., Veys, E., Zeidler, H. European Spondyloarthropathy Study Group (ESSG) preliminary criteria for the classification of spondyloarthropathy. Arthritis Rheum 1991, 34, 1218–1227.
Bennet, P.H., Burch, T.A. New York symposium on population studies in the rheumatic diseases: new diagnostic criteria. Bull Rheum Dis 1967, 17, 453–458.
Rooney, P.J., Jenkins, R.T., Buchanan, W.W. A short review of the relationship between intestinal permeability and inflammatory joint disease. Clin Exp Rheumatol 1990, 8, 75–83.
Bjarnason, J., Zanelli, G., Levi, A.J., Gumpec, M.J. The gut and rheumatoid arthritis. Br J Rheumatol 1987, 26, 67–68.
De Vos, M., Cuvelier, C., Mielants, H., Veys, E., Barbier, F., Elewaut, A. Ileocolonoscopy in seronegative spondyarthropathy. Gastroenterology 1989, 96, 339–344.
Mielants, H., De Vos, M., Goemaerer, S., Schecstraete, K., Cuvelier, C., Goethals, K., Haertens, M., Ackerman, C., Veys, E.M. Intestinal mucosal permeability in inflammatory rheumatic disease. J Rheumatol 1991, 18, 394–400.
Bax, D.E., Amos, R.S. Sulphasalazine: a safe, effective agent for prolonged control of rheumatoid arthritis. A comparison with sodium aurothiomalate. Ann Rheum Dis 1985, 44, 194–198.
Feltelius, N., Hallgren, R. Sulphasalazine in ankylosing spondylitis. Ann Rheum Dis 1986, 45, 396–399.
Nissila, M., Lehtinen, K., Leirisalo-Repo, M., Luukkainen, R., Mutru, O., Yli-Kerttula, U. Sulphasalazine in the treatment of ankylosing spondylitis. Arthritis Rheum 1988, 31, 1111–1116.
Cuvelier, C., Barbatis, C., Mielants, H., De Vos, M., Roels, H., Veys, E. Histopathology of intestinal inflammation related to reactive arthritis. Gut 1987, 28, 394–401.
Grillet, B., De Clerk, L., Dequeker, J., Rutgeerts, P., Geboes, K. Systematic ileocolonoscopy and bowel biopsy study in spondyloarthropathy. Br J Rheumatol 1987, 26, 338–340.
Simenon, G., Van Gossum, A., Adler, M. Macroscopic and microscopic gut lesions in seronegative spondyloarthropathies. Br J Rheumatol 1985, 17, 1491–1496.
Bjarnason, I., Peters, T.J. Intestinal permeability, nonsteroidal anti-inflammatory drug enterophathy and inflammatory bowel disease: an overview. Gut Festschrift 1989, 22–28.
Tanner, A.R., Raghunath, A.S. Colonic inflammation and nonsteroidal anti-inflammatory drug administration. Digestion 1988, 41, 116–120.
Morris, AJ.J., Madhok, R., Sturrock, R.D., Cappel, H.A., Mackenzie, J.F. Enteroscopic diagnosis of small bowel ulceration in patients receiving nonsteroidal anti-inflammatory drugs. Lancet 1991, 337, 520.
Mielants, H., Goemaere, S., De Vos, M., Schelstraete, K., Goethals, K., Maertens, M., Ackerman, C., Veys, E.M. Intestinal mucosal permeability in inflammatory rheumatic disease. I. Role of antinflammatory drugs. J Rheumatol 1991, 18, 389–393.
Cuvelier, C., Mielants, H., De Vos, M., Veys, E., Roels, H. Immunoglobulin containing cells in terminal ileum and colorectum of patients with arthritis related gut inflammation. Gut 1988, 29, 916–925.
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Altomonte, L., Zoli, A., Veneziani, A. et al. Clinically silent inflammatory gut lesions in undifferentiated spondyloarthropathies. Clin Rheumatol 13, 565–570 (1994). https://doi.org/10.1007/BF02242995
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DOI: https://doi.org/10.1007/BF02242995