Severe case of Crohn’s disease with extraintestinal joint manifestation and psoriasis
Authors:
J. Hurňáková 1,2; P. Drastich 3; M. Sedláčková 4; R. Horváth 1,5; L. Petrů 1,2; K. Grobelná 1,2; J. Gatterová 1; K. Pavelka 1,2
Authors‘ workplace:
Revmatologický ústav, Praha
1; 1. lékařská fakulta, Univerzita Karlova, Praha
2; Institut klinické a experimentální medicíny, Praha
3; Fakultní Thomayerova nemocnice, Praha
4; Fakultní nemocnice Motol, Praha
5
Published in:
Čes. Revmatol., 24, 2016, No. 2, p. 47-52.
Category:
Case Report
Overview
Authors describe a case report of 70 years old female patient with autoimmune disease affecting skin, gastrointestinal, and musculoskeletal systems and present here a variable organ involvement that may occur in patients with spondyloarthropathies.
Initially, our patient presented only with mild psoriatic skin lesions. Afterwards, arthritis of wrist and left knee appeared that raised a suspicion on diagnosis of psoriatic arthritis. Later on, bloody stools along with fevers, weight loss and anemization occurred and she was diagnosed with idiopathic bowel disease – Cohn’s disease. Subsequently, gastrointestinal manifestation was dominant along the whole course of the disease. Despite intensive treatment, including biologic agents (TNFα blockers), she had repeatedly very severe systemic manifestations with septic complications and several acute surgery interventions. Terminal ileostomy was performed as the final surgery solution in our patient.
In the last years, rheumatic manifestations characterized by tendinopathy of Achilles tendons along with arthritis of knee joints appeared, and enteropathic arthritis with psoriasis was diagnosed in HLAB27 positive patient.
A case report presented here aimed to demonstrate that patients suffering from spondyloarthropathies may have a variable organ involvement with a variable disease course and may be treatment refractory despite of very intensive interventions. As spondyloarthropathies are group of distinct diseases with a common genetic predisposition and similar clinical features, recognition of their pathogenic pathways could aid to search for new therapeutical improvements.
Key words:
Psoriasis, Crohn’s disease, arthritis, HLA B-27, biologic therapy, spondyloartritis
Sources
1. Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70(1): 25–31.
2. Rudwaleit M, van der Heijde D, Landewe R. Development of ASAS for axial spondyloarthritis, validation of final section. Ann Rheum Dis 2009; 68: 777–83.
3. Braun J, van der Berg, Baraliakos X, et al. 2010 update of the ASSA/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011; 70: 896–904.
4. Duerr RH, Taylor KD, Brant SR, et al. A genome-wide association study identifies IL23R as an inflammatory bowel disease gene. Science 2006; 314(5804): 1461–146.
5. van Praet L, van den Bosch F, Mielants H, Elewaut D. Mucosal inflammation in spondylarthritides: past, present, and future. Current Rheumatology Reports 2011; 13(5): 409–415.
6. Laukens D, Peeters H, Marichal D, et al. CARD15 gene polymorphisms in patients with spondyloarthropathies identify a specific phenotype previously related to Crohn’s disease. Annals of the Rheumatic Diseases 2005; 64(6): 930–935.
7. Štolfa J. Psoriatická artritida. In: Pavelka K, Vencovský J, Horák P, et al., eds. Revmatologie. Praha: Maxdorf; 2012. p 308–332.
8. Wilson FC, Icen M, Crowson CS, et al. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum 2009; 61: 233–239.
9. Gelfand JM, Gladman DD, Mease PJ, Smith N, Margolis DJ, Nijsten T, Stern RS, Feldman SR, Rolstad T. Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol 2005; 53(4): 573.
10. Gladman DD, Ritchlin C, Helliwell PS. Psoriatic arthritis clinical registries and genomics. Ann Rheum Dis 2005; 64(Suppl 2): ii103–ii 105¨.
11. Veys E, Mielants H. Entheropatic arthropathies: diagnosis, pathophysiology and treatment. In: Hochberg M, Silamn A, Smolen J, et al., editors. Rheumatology. London: Mosby, Elsevier; 2008. p 1189–97.
12. Rodríguez-Reyna TS, Martínez-Reyes C, Yamamoto-Furusho JK. Rheumatic manifestations of inflammatory bowel disease. World Journal of Gastroenterology 2009; 15(44): 5517–5524.
13. Orchard TR, Wordsworth BP, Jewell DP. Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut 1998; 42(3): 387–391.
14. Pavelka K. Enteropatické spondyloartritidy. In: Pavelka K, Vencovský J, Horák P, et al., eds. Revmatologie. Praha: Maxdorf; 2012. p 332–335.
15. Kaufmann HJ, Taubin HL. Nonsteroidal anti-inflammatory drugs activate quiescent inflammatory bowel disease. Annals of Internal Medicine 1987; 107(4): 513–516.
16. Bjarnason I, Hayllar J, MacPherson AJ, Russell AS. Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans. Gastroenterology 1993; 104(6): 1832–1847.
17. Peluso R, Atteno M, Iervolino S, et al. Methotrexate in the treatment of peripheral arthritis in ulcerative colitis. Reumatismo. 2009; 61(1): 15–20.
18. Vavřík P. Základy revmatochirurgie. In: Pavelka K, Vencovsky J, Horak P, et al., editors. Revmatologie. Revmatologie. Praha: Maxdorf; 2012. p 248–259.
Labels
Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
2016 Issue 2
Most read in this issue
- Severe case of Crohn’s disease with extraintestinal joint manifestation and psoriasis
- Recent normative systems and risk factors in polymyalgia rheumatica