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Cui R, Wang Q, Zhang H, Wu S, Wan XJ, Dai SM. Correspondence on '2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus' by Aringer et al. Ann Rheum Dis 2022; 81:e165. [PMID: 32753415 PMCID: PMC9380487 DOI: 10.1136/annrheumdis-2020-218546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Ran Cui
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qian Wang
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hua Zhang
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shan Wu
- Department of Endoscopy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xin-Jian Wan
- Department of Endoscopy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Sheng-Ming Dai
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Yeh H, Wu RC, Tsai WS, Kuo CJ, Su MY, Chiu CT, Le PH. Systemic lupus erythematosus complicated by Crohn's disease with rectovaginal fistula. BMC Gastroenterol 2021; 21:206. [PMID: 33964869 PMCID: PMC8106151 DOI: 10.1186/s12876-021-01801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 05/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease, and few cases combine with Crohn’s disease. We present the first SLE patient concurrent with Crohn’s disease and rectovaginal fistula. She was successfully treated with vedolizumab and surgical intervention. Besides, she also had a rare opportunistic infection, cryptococcal pneumonia, in previous adalimumab treatment course. Case A 57 year-old female had SLE in disease remission for 27 years. She suffered from progressive rectal ulcers with anal pain and bloody stool, and Crohn’s disease was diagnosed. She received adalimumab, but the lesion still progressed to a rectovaginal fistula. Besides, she suffered from an episode of cryptococcal pneumonia under adalimumab treatment course. Therefore, we changed the biologics to vedolizumab, and arrange a transverse colostomy for stool diversion. She had clinical remission without active inflammation, but the fistula still persisted. Then, she received a restorative proctectomy with colo-anal anastomosis and vaginal repair. Follow-up endoscopy showed no more rectal ulcers or fistula tracts, and contrast enema also noted no residual rectovaginal fistula. Conclusion When a SLE patient had unusual rectal ulcers, Crohn’s disease should be considered. Biologics combined with surgical intervention is an optimal solution for Crohn’s disease with rectovaginal fistula. Although cryptococcal pneumonia is a rare opportunistic infection in the biological treatment, we should always keep it in mind.
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Affiliation(s)
- Heng Yeh
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Wen-Sy Tsai
- Department of Colon and Rectal Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Jung Kuo
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Taiwan Association of the Study of Small Intestinal Disease, Taoyuan, Taiwan
| | - Ming-Yao Su
- Department of Gastroenterology and Hepatology, New Taipei City Municipal Tucheng Hospital (Chang Gung Memorial Hospital, Tucheng Branch), Tucheng, Taiwan.,Taiwan Association of the Study of Small Intestinal Disease, Taoyuan, Taiwan
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Taiwan Association of the Study of Small Intestinal Disease, Taoyuan, Taiwan
| | - Puo-Hsien Le
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan. .,Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan. .,Taiwan Association of the Study of Small Intestinal Disease, Taoyuan, Taiwan.
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Sohn KC, Heo WG, Chu MS, Kim EJ, Chung JH, Choi SC, Yun KJ, Seo GS. [Rectal Ulcer Developed in Systemic Lupus Erythematosus without Ischemic Colitis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:299-302. [PMID: 31132828 DOI: 10.4166/kjg.2019.73.5.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/09/2019] [Accepted: 01/27/2019] [Indexed: 11/03/2022]
Abstract
Rectal involvement by systemic lupus erythematosus (SLE) is quite rare. Approximately 14 cases have been reported worldwide, but only one with ischemic colitis has been reported in Korea. A 17-year-old female patient was hospitalized with abdominal pain and hematochezia. Sigmoidoscopy revealed only a simple rectal ulcer without ischemic colitis. cytomegalovirus and bacterial infections were excluded. A sigmoidoscopic rectal biopsy indicated a rectal invasion by SLE, but the patient showed an acute worsening conditions that did not respond to treatment. This paper reports a case of rectal ulcer that developed in SLE without ischemic colitis with a review of the relevant literature.
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Affiliation(s)
- Ki Chang Sohn
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Won Gak Heo
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Min Su Chu
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Eui Joong Kim
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Jong Hyeok Chung
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Suck Chei Choi
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Ki Jung Yun
- Departments of Pathology, Wonkwang University School of Medicine, Iksan, Korea
| | - Geom Seog Seo
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
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García-Carrasco M, Mendoza-Pinto C, Munguía-Realpozo P, Méndez-Valderrabano F, Méndez Martínez S, Etchegaray Morales I, Montiel-Jarquín Á, López-Colombo A, Schmulson M. Functional gastrointestinal disorders in women with systemic lupus erythematosus: A case-control study. Neurogastroenterol Motil 2019; 31:e13693. [PMID: 31373090 DOI: 10.1111/nmo.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/15/2019] [Accepted: 07/20/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystemic involvement. Gastrointestinal (GI) manifestations are frequent but functional gastrointestinal disorders (FGIDs) have scarcely been studied in SLE. To determine the prevalence of FGIDs and their potential risk factors in SLE female patients vs controls. METHODS Systemic lupus erythematosus patients meeting the American College of Rheumatology (ACR) criteria and controls completed the Rome III questionnaire for FGIDs and a structured interview to assess sociodemographic, clinical, and treatment variables after excluding organic GI diseases. Logistic regression was used to determine risk factors (ie, alcohol drinking, medications) for FGIDs. KEY RESULTS Responders included 113 SLE patients and 122 age-matched controls. The presence of at least one FGIDs was higher in SLE (73.4%) vs controls (54.1%), P = .003. The most frequent FGIDs in SLE patients were nausea and vomiting disorders (NVD), belching disorders, globus, anorectal pain, functional heartburn (FH), and functional bloating (FB). After adjustment for confounding variables, SLE was associated with NVD (OR: 7.1, 95% CI: 2.7-19.1) globus (3.5, 1.3-9.3), anorectal pain (3.4, 1.4-8.4), and FH (2.5, 1.5-4.4). The simultaneous presence of >1 FGID was more common in SLE patients than controls (69.8% vs 31.8%). Glucocorticoids (5.2, 1.3-19.9) and non-steroidal anti-inflammatory drugs (NSAIDs; 3.0, 1.1-8.0) were associated with any FGID in SLE patients while alcohol drinking with gallbladder/sphincter of Oddi disorders 7.4 (1.1-47.3). CONCLUSIONS AND INFERENCES Functional gastrointestinal disorders are more frequent in SLE patients compared with controls. Medication that may alter gastrointestinal homeostasis, such as glucocorticoids and NSAIDs, are potential risk factors for FGIDs in SLE.
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Affiliation(s)
- Mario García-Carrasco
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México.,Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, IMSS, Puebla, México.,Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México.,Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, IMSS, Puebla, México.,Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Pamela Munguía-Realpozo
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México
| | - Fabiola Méndez-Valderrabano
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México
| | - Socorro Méndez Martínez
- Research in Health Coordination, Puebla Delegation, Instituto Mexicano del Seguro Social, Puebla, México
| | - Ivet Etchegaray Morales
- Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Álvaro Montiel-Jarquín
- Division of Health Research, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México
| | - Aurelio López-Colombo
- State Research and Education Department, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México
| | - Max Schmulson
- Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Investigación en Medicina Experimental, Facultad de Medicina-Universidad Nacional Autónoma de México (UNAM)-Hospital General de México, Dr. Eduardo Liceaga., Mexico City, México
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Abstract
Gastrointestinal (GI) symptoms are common among patients with systemic lupus erythematosus (SLE), although only rarely are they caused by active organ system involvement from SLE itself. Rapid diagnosis and appropriate treatment of lupus enteritis and other GI manifestations of SLE are critical, because of the potential for organ and life-threatening complications. The 3 main variants of lupus enteritis are lupus mesenteric vasculitis, intestinal pseudo-obstruction, and protein-losing enteropathy. These GI manifestations and others in patients with SLE are reviewed here.
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