Arthritis associated with jejunoileal bypass

Abstract

Arthritis is a common complication of small bowel bypass, occurring in 5-2096 of the postsurgical patients. Thirteen patients with arthritis related to jejunoileal bypass were studied. These patients had a symmetrical polyarthritis, and 8 also had extraarticular connective tissue disease manifestations. Immunologic evaluations were done on these patients and on a control group of 12 age-and sex-matched postintestinal bypass patients without arthritis. The incidence of positive ANA, rheumatoid factors, immune complexes, and antibodies to intestinal flora was the same in both groups. Patients in both groups showed similar changes in numbers of circulating T and B lymphocytes. More patients in the group with arthritis than in the control group had elevated IgA levels (38% versus 8%), but the difference was not significant (P > 0.05). This study demonstrates that immunologic abnormalities occur after jejeunoileal bypass irrespective of the onset of arthritis or related symptoms. No specific immunologic abnormalities could be associated with the arthritis occurring after small bowel bypass.

Bowel-Associated Dermatosis-Arthritis Syndrome: Bowel Bypass Syndrome Without Bowel Bypass

“…The positive antinuclear antibody test at a titer of 1:4,096 in this patient is unexplained, but currently there is no other indication that she has lupus erythematosus. In a study by Zapanta and associates, 16 results of the antinuclear antibody test were positive in four patients in the arthritis group and in two subjects in the control group. In three patients in the arthritis group, the result of this test reverted to negative after initiation of anti-inflammatory therapy; in the fourth patient, the test result became negative after the bypass was reversed.…”

Jejunoileal bypass as the main procedure in the onset of immune-related conditions: the model of BADAS

“…These patients had a symmetrical polyarthritis, and eight also had extra-articular connective tissue disease manifestations such as alopecia, pleurisy, Achilles tendinitis, carpal tunnel syndrome and erythema nodosum-like lesions. The incidence of antinuclear antibodies and rheumatoid factor positivity, the presence of immune complexes and antibodies to intestinal flora, and the numbers of circulating T and B lymphocytes were comparable to those of patients who did not develop arthritis following IBS [71].…”

The Bowel-Associated Arthritis–Dermatosis Syndrome (BADAS): A Systematic Review

“…Evidence that supports the role of immune complexes in the pathogenesis of BADAS includes: (i) the fact that circulating immune complexes have been documented in the sera of patients [ 7 , 57 , 58 ]; (ii) the detection of serum cryoglobulins in a proportion of patients [ 7 , 59 ]; (iii) the frequent demonstration of deposits of Ig and C3 in skin biopsies on direct immunofluorescence (see Table 3 ); and (iv) the fact that perivascular deposits of Ig and C3 have been found in the synovial tissue of a patient with BADAS on direct immunofluorescence [ 57 ].…”