Long-term evolution of gut inflammation in patients with spondyloarthropathy

Vos, Martine De; Mielants, Herman; Cuvelier, C; Elewaut, André; Em, Veys

doi:10.1053/gast.1996.v110.pm8964393

Cited by 192 publications

(106 citation statements)

References 5 publications

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“…Of 11 patients diagnosed with AS who subsequently developed IBD (type III arthritis), only 2 (18%) were B27 positive (24,25), when a rate of perhaps ϳ56% might have been anticipated. Results of other studies suggest that patients with IBD and SpA develop IBD first (and are B27 positive) (86).…”

Section: Interaction Between Hla-b27 Ileitis and Arthropathy?mentioning

confidence: 99%

“…The possibility that the inflammation represented preclinical Crohn's disease was studied by long-term followup of 123 of 354 patients with SpA who had undergone ileocolonoscopy. Eight (7%) of these patients, as well as 3 (3%) of a further 94 patients followed up by telephone, developed IBD (9 Crohn's disease and 2 ulcerative colitis) (16,24,25). Only 2 were HLA-B27 positive, and all were subsequently diagnosed as having AS.…”

Section: Spa and Intestinal Diseasementioning

confidence: 99%

“…With regard to ileal inflammation representing "subclinical" Crohn's disease, it is intriguing that some of the ileal biopsies (from patients with AS or ReA) revealed aphthoid ulceration, microgranuloma, or giant cells (16,24,25), histologic features that could be said to be suggestive of Crohn's disease. If these features are indeed suggestive of Crohn's disease, it might be anticipated that the prevalence and type of this ileitis was similar to that found in Crohn's ileitis.…”

Section: Spa and Intestinal Diseasementioning

confidence: 99%

See 2 more Smart Citations

Inflammatory bowel disease and spondylarthropathy

Smale

Natt

Orchard

et al. 2001

Arthritis & Rheumatism

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Section: Interaction Between Hla-b27 Ileitis and Arthropathy?mentioning

confidence: 99%

Section: Spa and Intestinal Diseasementioning

confidence: 99%

Section: Spa and Intestinal Diseasementioning

confidence: 99%

See 1 more Smart Citation

Inflammatory bowel disease and spondylarthropathy

Smale

Natt

Orchard

et al. 2001

Arthritis & Rheumatism

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“…Lesões inflamatórias no intestino, no entanto, têm sido identificadas pela histologia em 60% dos pacientes com espondiloartropatia, mesmo na ausência de qualquer sinal ou sintoma intestinal. As lesões endoscópicas mais raras e constituídas, principalmente, de pequenas erosões, encontram-se presentes em apenas 30% dos pacientes (14,(37)(38)(39)(40) . Dois tipos de inflamação têm sido descritos: um tipo agudo, que lembra uma colite infecciosa, e outro com características crônicas, que se assemelha à inflamação da DC.…”

Section: Introductionunclassified

“…Na forma crônica, as criptas estão distorcidas, há atrofia na superfície das vilosidades e o infiltrado da lâmina própria tem população celular mista. O tipo agudo tem sido identificado nos pacientes com artrite reativa secundária a uma infecção intestinal bacteriana e as lesões com características crônicas são mais prevalentes nos pacientes com EA ou com espondiloartropatia indiferenciada (38,40) . A semelhança entre o padrão de acometimento articular dos pacientes com DC e RCU com o de indivíduos com espondiloartropatia, que apresentam envolvimento subclí-nico do intestino, sugere a possibilidade de a inflamação intestinal ter um papel patogenético na artrite.…”

Section: Introductionunclassified

Manifestações articulares em pacientes com doença de Crohn e retocolite ulcerativa

Lanna¹,

Ferrari²,

Carvalho³

et al. 2006

Rev. Bras. Reumatol.

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RESUMOOs sintomas articulares constituem a manifestação extra-intestinal mais comum em pacientes com doença de Crohn e com retocolite ulcerativa. Reconhecida como artrite colítica, e mais recentemente, artrite enteropática, está classificada como uma das doenças do grupo das espondiloartropatias. Reconhecidamente, há dois padrões de acometimento articular: 1) periférico, habitualmente, associado aos períodos de atividade da doença intestinal e sem associação com o antígeno HLA B27, e 2) axial, caracterizado por espondilite e sacroiliíte, com curso clínico e radiográfico independente da doença intestinal e associado ao HLA B27. Palavras ABSTRACTJoint involvement is the most commom extraintestinal manifestation in patients with Crohn's disease and ulcerative colitis. The colitic arthritis, lately called enteropathic arthritis, is classified as one of the diseases of the spondyloarthropathies group. There are two patterns of joint involvement: 1) peripheral arthritis, usually coincides with exacerbations of the inflammatory bowel disease and is not associated with the HLA B27 antigen; and 2) axial involvement, characterized by spondylitis and sacroiliitis, which the clinical course is independent of the intestinal disease, and has an association with HLA B27.Keywords: ar thritis, inflammator y bowel disease, spondyloarthropathy, Crohn's disease, ulcerative colitis. INTRODUÇÃONa sua conceituação mais ampla, a doença inflamatória intestinal (DII) corresponde a qualquer processo inflamatório envolvendo o trato gastrintestinal, seja ele agudo ou crônico. A doença de Crohn (DC) e a retocolite ulcerativa (RCU) representam as duas principais formas de apresentação da DII, de causa desconhecida (1) . A despeito de constituírem doenças distintas, compartilham aspectos clínicos e epidemiológicos, sugerindo a possibilidade de fatores etiológicos comuns. O curso clínico, cujas manifestações principais são diarréia, dor abdominal e sangramento retal, caracteriza-se por períodos de remissão e exacerbação, e apresenta complicações as mais diversas. Associam-se, com certa freqüência, manifestações extra-intestinais tais como articulares, cutâneas, oculares, hepatobiliares e vasculares, que podem preceder, acompanhar ou suceder a doença intestinal. A etiopatogenia da DII é multifatorial, com a participação de fatores genéticos, intraluminais, alterações na barreira do epitélio intestinal e resposta imunológica anormal da mucosa. Estes fenômenos determinam a ativação da cascata imunoinflamatória, que resulta em lesão continuada da mucosa do intestino (2,3) . Os sintomas articulares constituem a manifestação extra-intestinal mais comum em pacientes com RCU e DC. Apesar do conhecimento da existência de uma poliartrite em associação às duas enfermidades por décadas, até 1959, acreditava-se que isto refletia a co-existência delas com a artrite reumatóide(AR) (4) . Nesta época, o quadro ficou mais bem definido, quando Wright e Watkinson (5) , estudando 108 pacientes com RCU, identificaram em 15,7% deles um tipo de artrite com caracterí...

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Immunomodulatory effects of anti-tumor necrosis factor ? therapy on synovium in spondylarthropathy: Histologic findings in eight patients from an open-label pilot study

Baeten

Kruithof

Bosch

et al. 2001

Arthritis & Rheumatism

173

106

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Objective To assess the effects of treatment with anti–tumor necrosis factor α (anti‐TNFα) on synovial histology in patients with spondylarthropathy (SpA) in order to confirm the effect on peripheral synovitis and to investigate the immunologic mechanisms involved in anti‐TNFα therapy. Methods Patients with treatment‐resistant SpA were treated with infliximab (5 mg/kg) at weeks 0, 2, and 6 in an open‐label pilot study. In 8 patients, synovial biopsy tissues obtained at baseline, week 2, and week 12 were used for histologic and immunohistochemical evaluation. Results In all 8 patients (3 with ankylosing spondylitis, 1 with undifferentiated SpA, and 4 with psoriatic arthritis), there was a clear clinical improvement in the peripheral arthritis after anti‐TNFα therapy. Histologic analysis of the synovial biopsy tissues indicated that the synovial lining layer thickness tended to decrease, with a significant reduction of CD55+ synoviocytes, at week 12. In the sublining layer, vascularity was reduced at week 12, with a decreased endothelial expression of vascular cell adhesion molecule 1 but not intercellular adhesion molecule 1, platelet endothelial cell adhesion molecule 1, and E‐selectin. Although at week 2 and week 12, the number of neutrophils and CD68+ macrophages in the sublining layer was decreased, the overall degree of inflammatory infiltration remained unchanged. This could be related to the lymphocyte infiltration since at week 12, only CD4+ cells (but not CD3+, CD45RO+, and CD8+ cells) tended to decrease, while CD20+ lymphocytes and plasma cells were clearly increased. Conclusion The reduction in lining layer thickness, vascularity, and infiltration with neutrophils and macrophages paralleled the beneficial effect of anti‐TNFα therapy on peripheral synovitis in 8 patients with different subtypes of SpA. The adhesion molecule expression, T cell infiltration, and, most important, B cell infiltration seemed to contrast with previous observations in RA. Although these preliminary data need to be confirmed in a larger cohort, they suggest distinct immunomodulatory mechanisms of anti‐TNFα in SpA.

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Long-term evolution of gut inflammation in patients with spondyloarthropathy

Cited by 192 publications

References 5 publications

Inflammatory bowel disease and spondylarthropathy

Inflammatory bowel disease and spondylarthropathy

Manifestações articulares em pacientes com doença de Crohn e retocolite ulcerativa

Immunomodulatory effects of anti-tumor necrosis factor ? therapy on synovium in spondylarthropathy: Histologic findings in eight patients from an open-label pilot study

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