Intestinal Histological and Ultrastructural Inflammatory Changes in Spondyloarthropathy and Rheumatoid Arthritis

Abstract

To determine the prevalence of morphologic bowel lesions in patients with inflammatory rheumatic diseases and to better define the interactions between intestinal and articular pathology, 177 patients [39 with reactive arthritis (ReA), 40 with psoriatic arthritis (PsA), 23 with ankylosing spondylitis (AS), 21 with undifferentiated spondyloarthropathy (USpA) and 54 with rheumatoid arthritis (RA)] underwent ileocolonoscopy followed by multiple biopsies of the large bowel and the ileum and ileocecal valve. Biopsies were then examined with light and electron microscopy. During the endoscopic examination various degrees of gut inflammation were observed in 13% of ReA, 5% of PsA, 26% of AS, 14% of USpA and 11% of RA patients. At the histological examination those percentages were respectively 51%, 45%, 48%, 38%, and 15%, and at the electron microscopic examination 76%, 53%, 90%, 60%, and 50%. Our results show that an involvement of the gut is a factor in a large percentage of patients with spondyloarthropathy and, to a lesser extent, with RA. The involvement of the intestine in RA manifests itself mainly in ultrastructural lesions, thus this involvement is not so obvious as in the spondyloarthropathies; however, it could nonetheless play an important role in the etiopathogenesis of this disease.

Inflammatory bowel disease and spondylarthropathy

“…These findings have been confirmed (Table 1), but with important differences that relate to the lower prevalence of the abnormalities in ReA and AS, the location of the inflammation, and, in the study by Porzio et al (19), a much lower prevalence of ileitis in B27-negative AS. Three studies (19)(20)(21) demonstrated that intestinal inflammation was equally or more prevalent in the colon than the ileum in patients with ReA or AS, whereas in the studies from Belgium the colon was found to be normal.…”

“…Leirisalo-Repo et al (20) reported the presence of histologic lesions in the colon or ileum in 50% of patients with rheumatoid arthritis (RA) and 28% of "controls." Some of these differences are almost certainly due to subjective interpretation of subtle histologic abnormalities (22); however, the demonstration of a high prevalence of colonic inflammation in SpA and ileocolonic abnormality in RA (19,20,23) cannot be explained on these grounds and requires alternate explanation.…”

“…Three studies (19)(20)(21) demonstrated that intestinal inflammation was equally or more prevalent in the colon than the ileum in patients with ReA or AS, whereas in the studies from Belgium the colon was found to be normal. Leirisalo-Repo et al (20) reported the presence of histologic lesions in the colon or ileum in 50% of patients with rheumatoid arthritis (RA) and 28% of "controls."…”

Eosinophilic Gastroenteritis Associated with Rheumatoid Arthritis

“…Also, histologic changes were characterized by partial or complete loss of superficial epithelium, lymphocytes, plasma cells, granulocytes, and the presence of vasculitic lesions. [8][9][10][11][12] In these reports, no eosinophilic cells were seen in the histologic examination; however, in our case, we detected distinct eosinophilic infiltration on the bowel wall.…”

Bowel Involvement in Patients With Spondyloarthritis

“…[17], обследовавших 177 больных РЗ. Для изучения характера и тяжести поражения они проводили множест-венные биопсии слизистой оболочки (из каждого отдела толстой кишки) с последующим гистологическим и ульт-раструктурным анализом.…”