Pancreatitis in rheumatoid arthritis and the role of systemic vasculitis of autoimmune origin in the pathogenesis of pancreatitis – A postmortem clinicopathologic study of 161 patients

Abstract

Aim: The aim of this study was to determine the prevalence of acute liponecrotic (aLnP), acute relapsing liponecrotic (aRelLnP), and chronic liponecrotic pancreatitis (chrLnP) in RA, and analyze the possible role of systemic vasculitis of autoimmune origin (A-SV) in the pathogenesis of liponecrotic pancreatitis (LnP), furthermore to assess the predictive clinical laboratory parameters for LnP and A-SV. Patients and methods: At the National Institute of Rheumatology 9475 patients died between 1969 and 1992; among them 161 with RA and all of them were autopsied. RA was confirmed clinically according to the criteria of the American College of Rheumatology (ACR). Tissue samples of pancreas were available in 118 of 161 patients. Prevalence and histological patterns of pancreatitis were determined at autopsy and characterized histologically. Demographics and laboratory parameters of different patient cohorts were compared with the Student (Welch) t-probe. The relationship between aLnP or aRelLnP and A-SV, furthermore between chrRelP and A-SV were analyzed by Pearson's chi-squared (χ 2) test. Results: Pancreatitis with multiple liponecrotic foci (LnP) were found in 15 (12.71 %) of 118 patients; aLnP existed in 8 (53.33 %), aRelLnP in 4 (26.67 %), and liponecrotic foci in combination with chronic fibrotic pancreatitis (chrLnP) in 3 (20.0 %) of these 15 patients. A-SV complicated RA in 25 (21.18%) of 118 patients, and the pancreatic blood vessels were involved in 9 (36.00%) of these 25 patients; in 16 (64.00%) of 25 patients vasculitis was not found in the pancreas. The RA started later in female patients, complicated or associated with LnP, (55.4 years versus 50.15 at onset of disease), and led notably earlier to death (within 7.44 years versus 14.93); the difference of latter was significant (p <0.0396). The mean age of RA female patients, complicated by A-SV was significantly higher at onset of disease (60.57 years versus 48.33; p <0.0007), and the female patients with A-SV died significantly earlier (within 10.0 years versus 15.09; p <0.045). The link between A-SV and LnP was positive and significant (association's coefficient=0.7539, χ²=8.8418, p<0.003), which was resulted by the very strong positive correlation between A-SV and aRelLnP (χ²=17.6949, p<0.0000). The relationship between A-SV and aLnP (association's coefficient negative, (χ²=0.0231, p<0.88) or A-SV and chrLnP (association's coefficient negative, χ²=0.3570, p <0.55) was not significant. Discussion and conclusion: The risk of LnP or A-SV is higher in elderly female RA patients, and their chance of survival is lower than in males, or compared with RA patients who did not have LnP or A-SV. A-SV, as a basic complication of RA, should be regarded an important vasculogenic factor in the pathogenesis of aRelLnP, which may be regarded as a special manifestation of autoimmune pancreatitis or a vasculogenic entity in RA. The clinical significance of laboratory parameters (elevated erythrocyte sedimentation rate, increased C-reactive protein level, anemia, thromboc...

β-cell Related Amyloidosis Localized to the Islets of Langerhans, Type II Diabetes Mellitus and Liponecrotic Pancreatitis in Rheumatoid Arthritis: A Postmortem Clinicopathologic Statistical Study of 234 Autopsy Patients

“…AAa and IA are independent phenomena which may coexist in RA, based on the negative association coefficient and absence of significant relationship. Severe AAa may involve blood vessels of different calibers of the pancreas and should be regarded as important factors in the pathogenesis of aRelLnP [74]. The role of severe AAa in pathogenesis of fatal acute pancreatitis is confirmed by others as well [75][76][77].…”