Background The association between various rheumatic diseases and inflammatory bowel diseases is suggested by many clinical and experimental observations. Immunological disturbances play a crucial role in the pathogenesis of both rheumatic diseases and inflammatory bowel diseases (IBD), like ulcerative colitis (UC) and Crohn disease (CD). Numerous scientific reports suggest similar pathogenesis of IBD and spondyloarthropathies (SpA), but the patomechanisms linking these two groups of diseases are still being examined.
Objectives The aim of our study was to assess the prevalence of coexistence of various rheumatic diseases and inflammatory bowel diseases in a group of rheumatic patients (pts).
Methods This retrospective study was based on the analysis of 4000 clinical histories of patients with various rheumatic diseases, hospitalized in the University Department of Rheumatology and Connective Tissue Diseases between the years 2005 and 2011. We searched for the coexistence of various rheumatic diseases and inflammatory bowel disease (IBD) with clinically confirmed diagnosis. The diagnosis of all rheumatic diseases was established according to the current classification criteria. The diagnosis of IBD - UC or CD was confirmed by histopathological examination of gut.
Results The coexistence of IBD with a rheumatic disease was found in 15 (0,38%) of all rheumatic pts. Among them there were 13 pts with ulcerative colitis (UC) and 2 pts with Crohn disease (CD). Both pts with the diagnosis of CD had ankylosing spondylitis (AS). Among 4000 pts with various rheumatic diseases there were 921 pts with rheumatoid arthritis (RA); 342 pts with systemic lupus erythematosus (SLE); 95 pts with AS; 65 pts with psoriatic arthritis (PsA); 35 pts with Wegener’s granulomatosis. We found the association of UC with RA in 1 patient (0,11% all RA pts), with SLE in 5 pts (1,46% all SLE pts), with Wegener’s granulomatosis in 1 patient, with undifferentiated ANCA (+) vasculitis in 1 patient, with PsA in 1 patient. In 4 pts with UC enteric arthropathy was diagnosed. There were no pts with the coexistence of UC and AS. In the group of 5 pts with SLE there were only women, in the age of 28-49 years old. The coexistence of SLE was observed only with UC. The diagnosis of IBD had been established prior to the diagnosis of SLE in 80% cases, 2 to 11 years before the first symptoms of SLE. In 3/5 of pts renal involvement, leukopenia and thrombocytopenia were seen. The coexistence of IBD with inflammatory SpA we found in 4,4% of all SpA pts. Enteric arthropathy symptoms occurred 1 to 16 years before the diagnosis of IBD was established. AS and PsA diagnosis was made at the same time or later (0-4 years) than diagnosis of IBD. All pts with AS had the axial form of the disease, without peripheral joint involvement.
Conclusions We conclude that the coexistence of various rheumatic diseases and inflammatory bowel diseases with clinically confirmed diagnosis is relatively low. Inflammatory bowel diseases mainly coexist with inflammatory spondyloarthopaties and with systemic lupus erythematosus. Physicians should bear in mind the possibility of association of these two different groups of diseases and adjust the treatment to this particular clinical situation.
Disclosure of Interest None Declared
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