Rheumatology and the Gastrointestinal Tract

Abstract

Several associations of mesenchymal disease with gastrointestinal disease are discussed, e.g., scleroderma and its alimentary manifestations, erythema nodosum and pyoderma gangrenosum as complications of chronic ulcerative colitis, and the relationship between arthritis and ulcerative colitis. Most of the article is concerned with the relationship between peptic ulcer and arthritis, and the drugs used in therapy. Several reports in the literature are cited. A principal finding is that patients with rheumatoid disease are particularly prone to peptic ulcer. The pathogenesis of peptic ulcer depends upon the balance between digestive secretions and mucosal resistance in the stomach and duodenum. Several substances can be ulcerogenic, e.g., gastrin, histamine, aspirin, phenylbutazone and cinchophen. Possibly ulcerogenic are (large doses) testosterone and corticosteroids. Since corticosteroids are among the most beneficial drugs for the treatment of some mesenchymal diseases and ulcerative colitis, this point is an important one. We should not conclude that a disease is drug‐induced just because it follows administration of the drug. This is particularly applicable to peptic ulcer, which seems to occur secondarily or in association with a large variety of disorders.

On the Problem of Protein-Losing Enteropathy in Rheumatoid Arthritis and Generalized Sclerodermia

“…It can be found in generalized sclerodermia (pro gressive systemic sclerosis = PSS) and in dermatomyositis, but also in other diseases, such as rheumatoid arthritis (RA) and lupus erythematosus [7][8][9]. On the other hand, certain types of enteritis and colitis are very often asso ciated with a 'rheumatoid' or other type of arthritis or arthralgia [I, 12], Seiatin [9,10] regards the enteropathy as a primary phenomenon having aetiologic implications.…”