Rheumatologische Erkrankungen und der Gastrointestinaltrakt

ZusammenfassungDie meisten rheumatologischen Krankheitsbilder können Einfluss auf den Gastrointestinaltrakt haben. Dabei können intestinale Manifestationen (z. B. rheumatoide Vaskulitis, IgG4-assoziierte Pankreatitis, IgG4-assoziierte Cholangitis, Lupus-Enteritis, Polyarteriitis nodosa, Purpura Schoenlein-Henoch, nekrotisierende Vaskulitis), assoziierte intestinale Erkrankungen (chronisch-entzündliche Darmerkrankungen (CED), Zöliakie) und intestinale Komplikationen der rheumatologischen Erkrankung (z. B. Amyloidose, erosive Refluxerkrankung bei Sklerodermie) bzw. ihrer Behandlung (z. B. NSAR-Magenulcus, MTX-Mukositis, Soor-Ösophagitis, intestinale Tuberkulose, ulzerierende HSV-Ösophagitis, CMV-Kolitis) voneinander abgegrenzt werden. Dadurch kommen gastrointestinale Symptome bei Patienten mit rheumatologischen Erkrankungen sehr häufig vor. Die Diagnosestellung (er)fordert Gastroenterologen im interdisziplinären Behandlungsnetzwerk mit Rheumatologen. Insbesondere bei Behandlung von CED ergeben sich für die überschneidenden Zulassungsindikationen der zur Verfügung stehenden Medikamente in der interdisziplinären Absprache zwischen Rheumatologen und Gastroenterologen synergistische Behandlungsoptionen.

Lupus enteritis as a flare up of systemic lupus erythematosus- a case report and review

Systemic lupus erythematosus (SLE) generally affects young to middle-aged women, commonly presenting as a triad of fever, rash, and joint pain. Abdominal pain is a common symptom in patients with SLE. The leading causes of abdominal pain in SLE are lupus enteritis, pancreatitis, pseudo-obstruction, acalculous cholecystitis, mesenteric thrombosis, hepatic thrombosis, medications like (NSAIDS, MMF, steroids, HCQ), colon perforation. The incidence of abdominal pain in patients with SLE ranges from 8-40%, and the commonest cause is lupus enteritis. The following case describes a young woman presenting with lupus enteritis as a manifestation of SLE, the importance of early disease recognition, utilities of abdominal computed tomography (CT) in diagnosis, and current treatment protocols for lupus enteritis.

Clinical features of lupus enteritis: a single-center retrospective study

Background Lupus enteritis (LEn) is a rare complication of systemic lupus erythematosus (SLE). Timely diagnosis and treatment of LEn are necessary to prevent the most serious consequences — intestinal perforation, gastrointestinal bleeding, and death. We compared the clinical features of SLE patients with and without LEn. Methods The clinical data of LEn inpatients at Suining Central Hospital from July 2012 to June 2020 were examined. These LEn patients were matched (1:2 ratio) with concurrently hospitalized SLE patients who did not have LEn. The two groups were compared using multivariate logistic regression. Results We compared SLE inpatients with LEn (n = 43) and SLE inpatients without LEn (n = 86) at our institution. Multivariate logistic regression showed that ascites (odds ratio [OR]: 9.961, 95%CI: 2.215–44.802, P = 0.003), hydronephrosis (OR: 28.060, 95%CI: 2.303–341.962, P = 0.009), leukopenia (OR: 5.890, 95%CI: 1.813–19.135, P = 0.003), reduced complement C3 level (OR: 4.791, 95%CI: 1.605–14.300, P = 0.005), and elevated immunoglobin (Ig)A level (OR: 4.040, 95%CI: 1.307–12.487, P = 0.015) were independently associated with LEn. Within the LEn group, abdominal pain was the most common abdominal symptom (88.4%), and increased mesenteric fat attenuation (74.4%) and bowel wall thickening (58.1%) were the most common computed tomography (CT) findings. Most LEn patients (88.4%) required high-dose glucocorticoid therapy (≥ 80 mg methylprednisolone/day), and cyclophosphamide was the most commonly used immunosuppressant (62.8%). Conclusions Abdominal pain was the most common clinical symptom of LEn. Abdominal CT provides important information for detection and diagnosis of LEn. Ascites, hydronephrosis, leukopenia, hypocomplementemia (C3), and increased IgA were independently associated with LEn.

Lupus enteritis as a lone manifestation of SLE: rare but possible

A 28-year-old Southeast Asian non-pregnant woman with asthma and prior cholecystectomy presented to the emergency department with acute watery diarrhoea, intermittent abdominal pain and vomiting. Apart from abdominal tenderness, the rest of the physical examination was unremarkable. She had leucocytosis, alkaline phosphatase elevation and exudative ascites. Radiological imaging ruled out biliary leak and was only significant for circumferential small and large bowel thickening. Upper endoscopy and colonoscopy showed normal duodenal and colonic mucosae. Both infectious and malignancy workup were also unremarkable. Bereft of other systemic symptoms, autoimmune pathology was initially deemed unlikely; however, autoimmune workup revealed positive antinuclear antibody, double-stranded DNA, anti-Smith antibody, antinuclear ribonucleoprotein and hypocomplementaemia. With multidisciplinary collaboration, the patient was initiated on high-dose steroids, which dramatically improved her symptoms. She was discharged home with a steroid taper, and at 3 months of follow-up with her rheumatologist, she was continued on steroids and hydroxychloroquine.