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Rheumatologische Symptome bei gastroenterologischen Erkrankungen

Rheumatological symptoms with gastroenterological diseases

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Zusammenfassung

Im Verlauf einiger gastroenterologischer Erkrankungen können auch rheumatologische Symptome auftreten, die manchmal sogar führend sind. Wichtige Beispiele sind der Morbus Crohn, die Colitis ulcerosa, der Morbus Whipple und die glutensensitive Enteropathie. Arthralgien aber auch Arthritiden bis hin zu Destruktionen der Gelenke sind im Rahmen chronisch-entzündlicher Darmerkrankungen möglich. Pathogenetisch kommt dem Darm eine zentrale Rolle zu. Die Wechselbeziehung hepatologischer und rheumatologischer Erkrankungen ist ebenfalls komplex. Virale Hepatitiden können der klassischen rheumatoiden Arthritis ähnliche klinische Bilder präsentieren oder auch Symptome von Kollagenosen und Vaskulitiden zeigen. Nach der differenzialdiagnostischen Abgrenzung ist meist die Therapie der gastroenterologischen Grundkrankheit entscheidend für den Verlauf der rheumatologischen Symptomatik.

Abstract

In the course of several gastroenterological diseases rheumatological symptoms can occur which in some cases are even the main symptoms. Important examples are Crohn’s disease, ulcerative colitis, Whipple’s disease and gluten-sensitive enteropathy. Arthralgia and also arthritis with or without joint destruction are possible in the context of chronic inflammatory bowel diseases. Pathogenetically, the bowels are of central importance. The interrelation of hepatological and rheumatological diseases is also complex. Viral hepatitis can present a clinical picture resembling classical rheumatoid arthritis but also show symptoms of collagenosis and vasculitis. In addition to the differential diagnostic demarcation, in most cases therapy of the underlying gastroenterological disease is the determining factor regarding the development of rheumatological symptoms.

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Literatur

  1. Abraham S, Begum S, Isenberg D (2004) Hepatic manifestations of autoimmune rheumatic diseases. Ann Rheum Dis 63: 123–129

    Article  PubMed  CAS  Google Scholar 

  2. Bolten W (1996) Rheuma und Magen-Darm-Trakt. Dtsch Ärztebl 93: 380–384

    Google Scholar 

  3. Braun J, Baraliakos X, Listing J et al (2007) Differences in the incidence of flares or new onset of inflammatory bowel disease in patients with ankylosing spondylitis exposed to therapy with anti-TNF agents. Arthritis Rheum 57: 639–647

    Article  PubMed  CAS  Google Scholar 

  4. Buskila D (2009) Hepatitis-C associated rheumatic disorders. Rheum Dis Clin N Am 35: 111–123

    Article  Google Scholar 

  5. Calin A, Porta J, Fries J, Schurman D (1977) Clinical history as a screening test for ankylosing spondylitis. JAMA 237: 2613–2614

    Article  PubMed  CAS  Google Scholar 

  6. Ciccia F, Bombardieri M, Principato A et al (2009) Overexpression of interleukin-23, but not interleukin-17, as an immunologic signature of subclinical intestinal inflammation in ankylosing spondylitis. Arthritis Rheum 60: 955–965

    Article  PubMed  CAS  Google Scholar 

  7. De Vlam K, Mielants H, Cuvelier C et al (2000) Spondyloarthropathy is underestimated in inflammatory bowel disease: prevalence and HLA association. J Rheumatol 27: 2860–2865

    Google Scholar 

  8. Dougados M, Linden S van den, Juhlin R et al (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondyloarthopathy. Arthritis Rheum 34: 1218–1227

    Article  PubMed  CAS  Google Scholar 

  9. Feuerle GE, Junga NS, Marth T (2010) Efficacy of ceftriaxone or meropenem as initial therapies in Whipple’s disease. Gastroenterology 138: 478–480

    Article  Google Scholar 

  10. Gladman D (1991) Gastrointestinal-related arthritis and psoriatric arthritis. Curr Opin Rheumatol 3: 575–580

    Article  PubMed  CAS  Google Scholar 

  11. Gottschalk R, Neek G, Wigand R et al (1997) Hemochromatic arthropathy – an early manifestation of genetic hemochromatosis. Z Rheumatol 56: 156–162

    Article  PubMed  CAS  Google Scholar 

  12. Hisamatsu T, Suzuki M, Reinecker HC et al (2003) CARD15/NOD2 funktions as an antibacterial factor in human intestinal epithelial cells. Gastroenterology 124: 993–1000

    Article  PubMed  CAS  Google Scholar 

  13. Laukens D, Peeters H, Cruyssen BV et al (2006) Altered gut transcriptome in spondyloarthropathy. Ann Rheum Dis 65: 1293–1300

    Article  PubMed  CAS  Google Scholar 

  14. Leirisalo-Repo M, Turunen U, Stenman S et al (1994) High frequency of silent inflammatory bowel disease in spondyloarthropathy. Arthritis Rheum 37: 23–31

    Article  PubMed  CAS  Google Scholar 

  15. Li S, Kaur PP, Chan V, Berney S (2009) Use of tumor necrosis factor-alpha antagonists infliximab, etanercept and adalimumab in patients with concurrent rheumatoid arthritis and hepatitis B or hepatitis C: a retrospective record review of 11 patients. Clin Rheumatol 28: 787–791

    Article  PubMed  CAS  Google Scholar 

  16. Lowsky R, Archer GL, Fyles G et al (1994) Diagnosis of Whipple’s disease by molecular analysis of peripheral blood. N Engl J Med 331: 1343–1346

    Article  PubMed  CAS  Google Scholar 

  17. Michener WM, Caulfield M, Wyllie R, Farmer RG (1990) Management of inflammatory bowel disease: 30 years of observation. Cleve Clin J Med 57: 685–691

    PubMed  CAS  Google Scholar 

  18. Orchard TR, Wordsworth BP, Jewell DP (1998) Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut 42: 387–391

    Article  PubMed  CAS  Google Scholar 

  19. Peeters H, Cruyssen B van der, Laukens D et al (2004) Radiological sacroiliitis, a hallmark of spondylitis, is linked with CARD15 genepolymorphisms in patients with Crohn’s disease. Ann Rheum Dis 63: 1131–1134

    Article  PubMed  CAS  Google Scholar 

  20. Peeters H, Cruyssen B van der, Mielants H et al (2008) Clinical and genetic factors associated with sacroiliitis in Crohn’s Disease. J Gastroenterol Hepatol 23: 132–137

    PubMed  Google Scholar 

  21. Ramos-Casals M, Munoz S, Medina F et al (2009) Systemic autoimmune diseases in patients with hepatitis C virus infection: characterization of 1020 cases (the HISPAMEC registry). J Rheumatol 36: 1442–1448

    Article  PubMed  Google Scholar 

  22. Raoult D, Birg M, La Scola B et al (2000) Cultivation of the bacillus of Whipple’s disease. N Engl J Med 342: 620–625

    Article  PubMed  CAS  Google Scholar 

  23. Ronneberger M (2009) Enteropathische Arthritis. Z Rheumatol 4: 329–335

    Article  Google Scholar 

  24. Sartor R (1994) Cytokines in intestinal inflammation: Pathophysiological and clinical considerations. Gastroenterology 106: 533–539

    PubMed  CAS  Google Scholar 

  25. Schölmerich J (1996) Autoimmune Erkrankungen des Magen-Darm-Trakts. In: Peter HH, Pichler WJ (Hrsg) Klinische Immunologie. Urban & Schwarzenberg, München, pp 532 ff

  26. Simeon GE, Gossum A, Adler M et al (1990) Macroscopic and microscopic gut lesions in seronegative spondyloarthropathies. J Rheumatol 17: 1491–1494

    Google Scholar 

  27. Swidsinski A, Ladhoff A, Pernthaler A et al (2002) Mucosal flora in inflammatory bowel disease. Gastroenterology 122: 44–54

    Article  PubMed  Google Scholar 

  28. Terrier B, Saadoun D, Sene D et al (2009) Efficacy and tolerability of rituximab with or without PEGylated interferon alfa-2b plus ribavirin in severe hepatitis C virus related vasculitis. Arthritis Rheum 60: 2531–2540

    Article  PubMed  CAS  Google Scholar 

  29. Xavier R, Podolsky D (2007) Unravelling the pathogenesis of inflammatory bowel disease. Nature 448: 427–434

    Article  PubMed  CAS  Google Scholar 

  30. Yin Z, Braun J, Neure L et al (1997) Crucial role of IL-10/IL-12 balance in the regulation of the type 2 T-helper cytokine response in reactive arthritis. Arthritis Rheum 40: 1788–1797

    Article  PubMed  CAS  Google Scholar 

  31. Hunder GG (ed) (2005) Atlas of rheumatology, 4th edn. Springer, Berlin Heidelberg New York

  32. Gödde A, Müller-Ladner U (2006) Therapie der sekundären Arthropathien. Von der Psoriasis über den Morbus Reiter bis zur Hämochromatose. Internist 48: 1263–1268

    Article  Google Scholar 

  33. Guerrant RL et al (2002) Atlas of infectious diseases. Current Medicine LLC, Hoboken/NJ

  34. Wernicke D, Seipelt E, Schmidt WA et al (2006) Manifestation of rheumatoid arthritis in a patient with hereditary haemochromatosis. Rheumatol Int 26: 939–941

    Article  PubMed  Google Scholar 

  35. Furqaan A et al (2006) Gastroenterology and hepatology, vol 1, ch 5. Current Medicine LLC, Hoboken/NJ

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  1. Zentrum für Innere Medizin, Nordwest Krankenhaus Sanderbusch, Hauptstr., 26452, Sande, Deutschland

    W.-J. Mayet

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Mayet, WJ. Rheumatologische Symptome bei gastroenterologischen Erkrankungen. Gastroenterologe 6, 307–315 (2011). https://doi.org/10.1007/s11377-010-0501-1

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