Ankylosing Spondylitis and Chronic Inflammatory Lesions of the Intestines

Abstract

SummaryA case of poisoning as a result of the ingestion of an alcoholic podophyllum extract is described.The resulting toxic effects comprised an initial severe disturbance of consciousness followed by a state of confusion, and a fairly severe type of peripheral neuropathy.A substantial amount of recovery of function had occurred at the end of six months after ingestion of the podophyllin, but a residual neurological deficit was still evident at the end of 16 months.The mode of action and probable effects of the podophyllum extract are discussed briefly. GroupThis paper describes six cases in which ankylosing spondylitis was associated with chronic non-specific inflammatory lesions of the intestines. Four of these cases had chronic ulcerative colitis, one had Crohn's disease, and one had ulcerative colitis and Crohn's disease. The aetiology of ulcerative colitis and Crohn's disease is uncertain. Although it seems unlikely that they represent different man-ifestations of the same diseases, nevertheless there appears to be enough similarity between them to make differentiation difficult at times (Butler, 1953 ; Crohn, Garlock, and Yarnis, 1947), and we may be justified in considering them together. The diagnosis of Crohn's disease was made at operation in both our cases, while radiology with a barium-filled colon was relied on for the diagnosis of ulcerative colitis.The English literature has few references to the association of ankylosing spondylitis and ulcerative colitis. West (1949) (Marche, 1950; Ford, 1953 and for several years he had little trouble. In 1954 he complained of pain in the right knee, followed by pain in the back. Examination showed rigidity of the thoracic and lumbar spines, and limitation of movement of the cervical spine. There was an effusion in the right knee. X-ray examination showed typical changes of ankylosing spondylitis, with obliteration of the sacro-iliac joints and calcification of the spinal ligaments. Erythrocyte sedimentation rate was 20 mm. in one hour. He was treated by physical methods, with improvement. One month before this was written he had a further relapse of diarrhoea, with blood, and a barium enema showed a loss of haustration involving the descending and pelvic colon. For some years this man had had diffuse psoriasis.Case 3.-A man aged 48 complained in 1937 of diarrhoea and bloody stools. He was admitted to hospital, and ulcerative colitis was diagnosed. In 1942, while in hospital with a further attack, he first noted stiffness of his spine. Since then he has had intermittent attacks of ulcerative colitis. He also found that his neck was bending forward, and that he was unable to look up. In 1949 a diagnosis of ankylosing spondylitis was made. He was treated with deep x-ray therapy. Following this he developed his first attack of iridocyclitis, affecting the left eye. In 1950 he experienced a severe attack, affecting the right eye. X-ray examination revealed obliteration of both sacro-iliac joints, typical of ankylosing spondylitis. 1158 Nov. 16, 1957 ANKYLOSING...

Ankylosing spondylitis and inflammatory bowel disease. III. Clinical characteristics and results of histocompatibility typing (HLA B27) in 50 patients with both ankylosing spondylitis and inflammatory bowel disease.

“…It is well known that the incidence of inflammatory bowel disease (IBD) is increased in patients suffering from ankylosing spondylitis (AS) (Romanus, 1953;Steinberg and Story, 1957;Wilkinson and Bywaters, 1958;McBride et al, 1963;Jayson and Bouchier, 1968;Jayson et al, 1970;Meuwissen et al, 1978). On the other hand, there is an increased frequency of AS in IBD (Acheson, 1960;Moll et al, 1974;Dekker-Saeys, 1977).…”

Ankylosing spondylitis and auto-immunity

“…Although Whittingham et al (1971) associate rheumatoid arthritis and ulcerative colitis with these diseases, they found no correlation with ankylosing spondylitis, despite the known relationship between ulcerative colitis and ankylosing spondylitis (Acheson, 1960;Steinberg & Storey, 1957;Bennett, 1971). There is general agreement on the absence of significant anti-nuclear antibodies in the serum (Ritchie, 1967) and synovial fluid (Macsween et al, 1967) of patients with ankylosing spondylitis, but conflicting evidence on the signifi-cance of increased serum immunoconglutinins; Bienenstock & Block (1967) reporting significant increases in rheumatoid arthritis, ankylosing spondylitis, acute gout, Hashimoto's disease, Sjogren's syndrome and systemic lupus erythematosus, a group in which they find the presence of gout and ankylosing spondylitis 'unexpected'.…”

Extra-Gastrointestinal Manifestations of Inflammatory Bowel Disease May Be Less Common Than Previously Reported

“…As for so many features of IBD, the earliest publications about the associations of IBD with its extra-intestinal manifestations were case reports and case series in the first half of the twentieth century [15][16][17]. The currently recognised associations were described very rapidly.…”