SUMMARY To establish the prevalence of peripheral arthritis, radiographic sacroiliitis, and ankylosing spondylitis in patients with inflammatory bowel disease, 58 consecutive patients suffering from ulcerative colitis (UC) and 51 with Crohn's disease (CD) underwent a detailed rheumatological examination. In addition, all patients were screened for the presence of the antigen HLA B27.Peripheral arthritis was found in 14 (8 UC, 6 CD) patients (12 -8 %); radiographic sacroiliitis was diagnosed in 11 (5 UC, 6 CD) (10. 1 %), of whom 10 were asymptomatic; and ankylosing spondylitis was diagnosed in 2 UC and 2 CD patients (3.7 %). 18 * 9 % of the UC and 3.9 % of the CD patients were HLA B27 positive. One of the 11 patients with radiographic sacroiliitis and 2 of the 4 with ankylosing spondylitis had the HLA B27 antigen.Peripheral arthritis, radiographic sacroiliitis, and ankylosing spondylitis are apparently frequent manifestations in patients suffering from inflammatory bowel disease. Asymptomatic radiographic sacroiliitis in these patients appears to differ from idiopathic ankylosing spondylitis, both clinically and genetically. Evaluation of subjective rheumatological complaints, necessary for a confident diagnosis of ankylosing spondylitis, according to the New York criteria is difficult during a flare-up of the inflammatory bowel process, as was shown in 4 CD cases with marked limitation of lumbovertebral function and chest expansion, but no radiological abnormalities of the SI joints.

To establish the prevalence of inflammatory bowel disease in ankylosing spondylitis (AS), 79 AS patients underwent detailed medical screening, including sigmoidoscopic and roentgenological examination. 48 had gastrointestinal symptoms and the others did not. In 3 patients a diagnosis of Crohn's disease was made which was previously established. In all other patients inflammatory bowel disease could be excluded. The prevalence of inflammatory bowel disease in this series of patients with AS therefore was 3.8 %. An association between ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) seems to be firmly established (

Radiologic, endoscopic, and histologic features were analyzed in 15 patients with Crohn's disease of the colon. Radiologic findings were considered of diagnostic value in only 6 (40%), characteristic endoscopic lesions were found in 13 (87%) and diagnostic histologic features in 11 (73%). Endoscopy combined with biopsy was diagnostic in all 15 cases. The extent of involvement of endoscopy frequently disagreed with the radiologic assessment, particularly in the rectosigmoid area. Studies in 8 patients indicate that sigmoidoscopy and coloscopy with multiple biopsies provide an accurate alternative to radiology to estimate the extent and severity of the lesions and their evolution during corticosteroid and/or azathioprine treatment.

A patient is presented with Whipple’s disease. Before treatment, Haemophilus influenzae type e, sensitive to tetracycline was cultured from multiple small intestinal biopsies. This isolated micro-organism was structurally similar to the one observed in the tissue. All further culture experiments during and after treatment proved negative except for one biopsy from which a tetracycline-resistant H. influenzae type-e mutant was isolated. The immunological disturbances, mainly characterized by cutaneous anergy, in absence of major humoral or in vitro lymphocytic impairment, regressed during treatment together with clinical remission of the disease. These findings are considered in favour of the secondary nature of the immunological abnormalities.

No abstract