Skip to main content

Advertisement

SpringerLink
Log in

Gastrointestinal issues in children with rheumatologic disease

  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Distinctive arthritic patterns, some of which may parallel or even precede intestinal disease activity, are seen in inflammatory bowel disease. Some spondyloarthropathies are associated with transient ileocolic inflammation. Vasculitis frequently affects the gastrointestinal tract, predominantly manifesting with abdominal pain. In severe cases, intestinal ischemia and perforation may occur. Various arthritides are thought to be associated with other gastrointestinal diseases, such as celiac disease and hepatitis. The association between intestinal disease and arthritis is still being investigated. Interactions between the inflammatory intestinal cells and inflamed synovial cells have been demonstrated. Certain intestinal bacteria such as Klebsiella pneumoniae are suspected to play a role as triggers for the development of arthropathies. Genetic factors, especially human leukocyte antigen associations, are also being increasingly investigated for better characterization of the types of arthritis and possible prognostic implications. Various therapies, including nonsteroidal anti-inflammatory drugs, used to treat rheumatologic diseases have the potential to cause gastrointestinal complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Smale S, Natt RS, Orchard TR, et al.: Inflammatory bowel disease and spondyloarthropathy. Arthritis Rheum 2001, 44:2728–2736. This was an excellent review of inflammatory bowel disease concentrating on spondyloarthropathy, but also discussing all types of arthritis. Reviewed the literature focusing on HLA genotype, findings of intestinal inflammation, and various treatments. Provided the groundwork for mechanisms of intestinal and joint inflammation as modified by genetic susceptibility.

    Article  PubMed  CAS  Google Scholar 

  2. Palm O, Moum B, Jahnsen J, Gran JT:The prevalence and incidence of peripheral arthritis in patients with inflammatory bowel disease: a prospective population-based study (the IBSEN study). Rheumatology 2001, 40:1256–1261. Documented much lower incidence (0.8%) of peripheral arthritis in a defined population of patients with inflammatory bowel disease, based on physical examination by a rheumatologist. There was a 12% incidence of joint complaints based on patients’ self-reporting.

    Article  PubMed  CAS  Google Scholar 

  3. Salvarani C, Vlachonikolis IG, van der Heijde DM, et al.: Musculoskeletal manifestations in a population-based cohort of inflammatory bowel disease patients. Scand J Gastroenterol 2001, 36:1307–1313.

    Article  PubMed  CAS  Google Scholar 

  4. Queiro R, Maiz O, Intxausti J, de Dios JR, et al.:Subclinical sacroiliitis in inflammatory bowel disease: a clinical and follow-up study. Clin Rheum 2000, 19:445–449.

    Article  CAS  Google Scholar 

  5. Stafford L, Youssef PP:Spondyloarthropathies: an overview. Intern Med J 2002, 32:40–46.

    Article  PubMed  CAS  Google Scholar 

  6. Lee CR, Kim WH, Cho YS, et al.:Colonoscopic findings in intestinal BehÇet’s disease. Inflamm Bowel Dis 2001, 7:243–249. Described the colonoscopic findings in 94 patients with what was labeled “intestinal” BehÇet’s. Predominant finding was either solitary or a few deep, but discrete ulcers in the ileocecal region.

    Article  PubMed  CAS  Google Scholar 

  7. Kari JA, Shah V, Dillon MJ:BehÇet’s disease in UK children: clinical features and treatment including thalidomide. Rheumatology 2001, 40:933–938. There should be a honorable mention for this small series that included children and discussed presentation, treatment, and outcome with the general impression that the course of BehÇet’s disease was similar to that of adults.

    Article  PubMed  CAS  Google Scholar 

  8. Solans R, Bosch JA, Perez-Bocanegra C, et al.:Churg-Strauss syndrome: outcome and long-term follow-up of 32 patients. Rheumatology 2001, 40:763–771.

    Article  PubMed  CAS  Google Scholar 

  9. Guillevain L, Cohen P, Gayraud M, et al.: Churg-Strauss syndrome: clinical study and long-term follow-up of 96 patients. Medicine 1999, 78:26–37. This is an excellent retrospective review of Churg-Strauss syndrome, and discusses the course and outcome of 96 patients followed over 32 years.

    Article  Google Scholar 

  10. Lin TL, Wang CR, Liu MF, et al.: Multiple colonic ulcers caused by Churg-Strauss syndrome in a 15-year-old girl. Clin Rheumatol 2001, 20:362–364.

    Article  PubMed  CAS  Google Scholar 

  11. Saulsbury F: Henoch-Schönlein purpura in children: report of 100 patients and review of the literature. Medicine 1999, 78:395–409. Noteworthy review of Henoch-Schönlein purpura, an entity that is frequently handled by generalists alone. Reviewed the history of this acute, often self-limited vasculitis and the many clinical manifestations. Also discussed the role of therapy as well as outcome in 100 consecutive children seen over 20 years.

    Article  PubMed  CAS  Google Scholar 

  12. Krohn C, Till H, Haraida S, et al.: Multiple intestinal stenoses and peripheral gangrene: A combination of two rare surgical complications in a child with Kawasaki disease. J Pediatr Surg 2001, 36:651–653.

    Article  PubMed  CAS  Google Scholar 

  13. Sanders BM, West KW, Gingalewski C, et al.: Inflammatory pseudotumor of the alimentary tract: clinical and surgical experience. J Pediatr Surg 2001, 36:169–173.

    Article  PubMed  CAS  Google Scholar 

  14. Stephen TC, Bendon RW:One-month-old infant with multiple ulcers of stomach, small bowel, large bowel, and protein-losing enteropathy: case report. Pediatr Dev Pathol 2001, 4:100–103.

    Article  PubMed  CAS  Google Scholar 

  15. Shehata R, Al-Mayouf S, Al-Dalaan A, et al.: Juvenile dermatomyositis: clinical profile and disease course in 25 patients. Clin Exp Rheumatol 1999, 17:115–118.

    PubMed  CAS  Google Scholar 

  16. Picco P, Gattorno M, Vignola S, et al.:Clinical and biological characteristics of immunopathological disease-related erythema nodosum in children. Scand J Rheumatol 1999, 28:27–32. Interesting series of 22 children who presented with erythema nodosum and the eventual diagnosis made, which were predominantly infectious.

    Article  PubMed  CAS  Google Scholar 

  17. Len C, Hillario MOE, Kawakami E, et al.: Gastroduodenal lesions in children with juvenile rheumatoid arthritis. Hepatogastroenterology 1999, 46:991–996.

    PubMed  CAS  Google Scholar 

  18. Rensch MJ, Szyjkowski R, Shaffer RT, et al.:The prevalence of celiac disease autoantibodies in patients with systemic lupus erythematosus. Am J Gastroenterol 2001, 96:1113–1115.

    Article  PubMed  CAS  Google Scholar 

  19. Rivera J, Garcia-Monforte A, Pineda A, Nunez-Cortes JM: Arthritis in patients with chronic hepatitis C virus infection. J Rheumatol 1999, 26:420–424.

    PubMed  CAS  Google Scholar 

  20. Maillefert JF, Sibilia J, Toussirot E, et al.: Rheumatic disorders developed after hepatitis B vaccination. Rheumatology 1999, 38:978–983.

    Article  PubMed  CAS  Google Scholar 

  21. Salmi M, Jalkanen S: Human leukocyte subpopulations from inflamed gut bind to joint vasculature using distinct sets of adhesion molecules. J Immunol 2001, 166:4650–4657. In vitro experiment attempting to prove the presence of cellular interactions between cells from the inflamed gut and the inflamed synovium.

    PubMed  CAS  Google Scholar 

  22. May E, Marker-Hermann E, Wittig B, et al.:Identical T-cell expansions in the colon mucosa and the synovium of a patient with enterogenic spondyloarthropathy. Gastroenterology 2000, 119:1745–1755.

    Article  PubMed  CAS  Google Scholar 

  23. Tiwana H, Natt RS, Benitez-Brito R, et al.: Correlation between the immune responses to collagens type I, III, IV and V and Klebsiella pneumoniae in patients with Crohn’s disease and ankylosing spondylitis. Rheumatology 2001, 40:15–23. A study postulating that an increased immunopathophysiologic response to Klebsiella may be important in the initiation and perpetuation of intestinal inflammation in inflammatory bowel disease.

    Article  PubMed  CAS  Google Scholar 

  24. Picco P, Gattorno M, Marchese N, et al.: Increased gut permeability in juvenile chronic arthritides: a multivariate analysis of the diagnostic parameters. Clin Exp Rheumatol 2000, 18:773–778. A pediatric study demonstrating increased intestinal permeability in patients with different arthritides, using the lactulose/mannitol test.

    PubMed  CAS  Google Scholar 

  25. Fielder M, Pirt SJ, Tarpey I, et al.: Molecular mimicry and ankylosing spondylitis: possible role of a novel sequence pullulanase of Klebsiella pneumoniae FEBS Lett 1995, 369:243–248.

    Article  PubMed  CAS  Google Scholar 

  26. Orchard TR, Thiyagaraja S, Welsh KI, et al.:Clinical phenotype is related to HLA genotype in the peripheral arthropathies of inflammatory bowel disease. Gastroenterology 2000, 118:274–278. A relatively large study examining different HLA genotypes in Northern European patients with different types of arthropathies and with inflammatory bowel disease.

    Article  PubMed  CAS  Google Scholar 

  27. Wollheim FA: Enteropathic arthritis: how do the joints talk with the gut? Curr Opin Rheumatol 2001, 13:305–309.

    Article  PubMed  CAS  Google Scholar 

  28. Amoli MM, Mattey DL, Calvino MC, et al.:Polymorphism at codon 469 of the intercellular adhesion molecule-1 locus is associated with protection against severe gastrointestinal complications in Henoch-Schonlein purpura. J Rheumatol 2001, 28:1014–1018.

    PubMed  CAS  Google Scholar 

  29. Cheatum DE, Arvanitakis C, Gumpel M, et al.:An endoscopic study of gastroduodenal lesions induced by nonsteroidal anti-inflammatory drugs. Clin Ther 1999, 21:992–1003. A large multicenter study examining gastrointestinal complications of nonsteroidal anti-inflammatory drug use, clinically and endoscopically.

    Article  PubMed  CAS  Google Scholar 

  30. Mandell B:COX 2-selective NSAIDs: biology, promises, and concerns. Cleve Clin J Med 1999, 66:285–292.

    PubMed  CAS  Google Scholar 

  31. Uziel Y, Hashkes PJ, Kassem E, et al.:The use of naproxen in the treatment of children with rheumatic fever. J Pediatr 2000, 137:269–271.

    Article  PubMed  CAS  Google Scholar 

  32. Yeomans N, Wilson I, Langstrom G, et al.:Quality of life in chronic NSAID users: a comparison of the effect of omeprazole and misoprostol. Scand J Rheumatol 2001, 30:328–334. Well designed muticenter study comparing omeprazole, misoprostol, and placebo in treatment and prevention of nonsteroidal antiinflammatory drug-associated gastrointestinal complications

    Article  PubMed  CAS  Google Scholar 

  33. Lanas AI: Current approaches to reducing gastrointestinal toxicity of low-dose aspirin. Am J Med 2001, 110:70S-73S. The article provides a very useful comparison of the evidence of effective therapy in the prevention of aspirin-associated gastrointestinal toxicity.

    Article  PubMed  CAS  Google Scholar 

  34. Hassall E, Israel D, Shepherd R, et al.: Omeprazole for treatment of chronic erosive esophagitis in children: A multicenter study of efficacy, safety, tolerability and dose requirements. J Pediatr 2000, 137:800–807.

    Article  PubMed  CAS  Google Scholar 

  35. Ravelli A, Migliavacca D, Viola S, et al.: Efficacy of folinic acid in reducing methotrexate toxicity in juvenile idiopathic arthritis. Clin Exp Rheumatol 1999, 17:625–627.

    PubMed  CAS  Google Scholar 

  36. Jung JH, Jun JB, Yoo DH, et al.: High toxicity of sulfasalazine in adult-onset Still’s disease. Clin Exp Rheumatol 2000, 18:245–248.

    PubMed  CAS  Google Scholar 

  37. Menghini VV, Arora AS:Infliximab-associated reversible cholestatic liver disease. Mayo Clin Proc 2001, 76:84–86.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Gastroenterology, Nutrition and Liver Disease, Mount Sinai Medical Center, One Gustave Levy Place, Box 1656, 10029, New York, NY, USA

    Keith Benkov MD

Authors
  1. Mirna Chehade MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keith Benkov MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chehade, M., Benkov, K. Gastrointestinal issues in children with rheumatologic disease. Curr Rheumatol Rep 4, 458–465 (2002). https://doi.org/10.1007/s11926-002-0051-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-002-0051-8

Keywords

Search

Navigation