Rheumatologische Erkrankungen und der Gastrointestinaltrakt

Zusammenfassung

Die meisten rheumatologischen Krankheitsbilder können Einfluss auf den Gastrointestinaltrakt haben. Dabei können intestinale Manifestationen (z. B. rheumatoide Vaskulitis, IgG4-assoziierte Pankreatitis, IgG4-assoziierte Cholangitis, Lupus-Enteritis, Polyarteriitis nodosa, Purpura Schoenlein-Henoch, nekrotisierende Vaskulitis), assoziierte intestinale Erkrankungen (chronisch-entzündliche Darmerkrankungen (CED), Zöliakie) und intestinale Komplikationen der rheumatologischen Erkrankung (z. B. Amyloidose, erosive Refluxerkrankung bei Sklerodermie) bzw. ihrer Behandlung (z. B. NSAR-Magenulcus, MTX-Mukositis, Soor-Ösophagitis, intestinale Tuberkulose, ulzerierende HSV-Ösophagitis, CMV-Kolitis) voneinander abgegrenzt werden. Dadurch kommen gastrointestinale Symptome bei Patienten mit rheumatologischen Erkrankungen sehr häufig vor. Die Diagnosestellung (er)fordert Gastroenterologen im interdisziplinären Behandlungsnetzwerk mit Rheumatologen. Insbesondere bei Behandlung von CED ergeben sich für die überschneidenden Zulassungsindikationen der zur Verfügung stehenden Medikamente in der interdisziplinären Absprache zwischen Rheumatologen und Gastroenterologen synergistische Behandlungsoptionen.

Abstract

Most rheumatological disorders may have an impact on the gastrointestinal tract. In this context, intestinal manifestations of rheumatological disease (e. g., rheumatoid vasculitis, IgG4-associated pancreatitis and cholangitis, lupus enteritis, polyarteritis nodosa) should be distinguished from associated intestinal diseases (e. g., inflammatory bowel disease (IBD), celiac disease), intestinal complications of the disease (e. g., amyloidosis, reflux disease in sclerodermia) or intestinal complications of their treatment (e. g., gastrointestinal ulcers (NSAID), mucositis (MTX), oesophageal candidiasis, intestinal tuberculosis, herpes oesophagitis, CMV colitis in immunosuppressive therapy). As a result, gastrointestinal symptoms are very common in patients with rheumatological diseases. The correct diagnosis can be only established by the interdisciplinary approach of gastroenterologists and rheumatologists. Especially in the treatment of IBD, synergistic treatment options arise from the overlapping approval of the available drugs in the interdisciplinary consultation between rheumatologists and gastroenterologists.

Schlüsselwörter

Zöliakie - Gastrointestinaltrakt - chronisch-entzündliche Darmerkrankungen

Key words

Celiac Disease - Gastrointestinal Tract - Inflammatory Bowel Disease

Publikationsverlauf

Artikel online veröffentlicht:
10. November 2021

• Literatur

• 1 Hedin CRH, Vavricka SR, Stagg AJ. et al. The Pathogenesis of Extraintestinal Manifestations: Implications for IBD Research, Diagnosis, and Therapy. Journal of Crohn’s & Colitis 2019; 13: 541-554
• 2 Rosser EC, Mauri C. A clinical update on the significance of the gut microbiota in systemic autoimmunity. Journal of Autoimmunity 2016; 74: 85-93
• 3 Chu F, Shi M, Lang Y. et al. Gut Microbiota in Multiple Sclerosis and Experimental Autoimmune Encephalomyelitis: Current Applications and Future Perspectives. Mediators of Inflammation 2018; 2018: e8168717
• 4 Jeong Y, Kim J-W, You HJ. et al. Gut Microbial Composition and Function Are Altered in Patients with Early Rheumatoid Arthritis. Journal of Clinical Medicine 2019; 8: 693
• 5 Katz-Agranov N, Zandman-Goddard G. The microbiome and systemic lupus erythematosus. Immunol Res 2017; 65: 432-437
• 6 Mandl T, Marsal J, Olsson P. et al. Severe intestinal dysbiosis is prevalent in primary Sjögren’s syndrome and is associated with systemic disease activity. Arthritis Research & Therapy 2017; 19: 237
• 7 Patrone V, Puglisi E, Cardinali M. et al. Gut microbiota profile in systemic sclerosis patients with and without clinical evidence of gastrointestinal involvement. Sci Rep 2017; 7: 14874
• 8 Craig E, Cappelli LC. Gastrointestinal and Hepatic Disease in Rheumatoid Arthritis. Rheumatic Disease Clinics of North America 2018; 44: 89-111
• 9 Ebert EC, Hagspiel KD, Nagar M. et al. Gastrointestinal Involvement in Polyarteritis Nodosa. Clinical Gastroenterology and Hepatology 2008; 6: 960-966
• 10 Novák J, Márki-Zay J, Csiki Z. et al. Die Schoenlein-Henoch-Purpura bei Erwachsenen. Z Gastroenterol 2001; 39: 775-782
• 11 Nishiyama R, Nakajima N, Ogihara A. et al. Endoscope Images of Schönlein-Henoch Purpura. DIG 2008; 77: 236-241
• 12 Pattanaik D, Brown M, Postlethwaite BC. et al. Pathogenesis of Systemic Sclerosis. Front Immunol 2015; 6: 272
• 13 Brewer BN, Kamen DL. Gastrointestinal and Hepatic Disease in Systemic Lupus Erythematosus. Rheum Dis Clin North Am 2018; 44: 165-175
• 14 Shaikh FM, Sabu CB, Peirce TH. et al. Extensive intestinal ischaemic necrosis in Wegener’s granulomatosis. Gut 2006; 55: 1368-1369
• 15 Hedin CRH, Vavricka SR, Stagg AJ. et al. The Pathogenesis of Extraintestinal Manifestations: Implications for IBD Research, Diagnosis, and Therapy. Journal of Crohn’s & Colitis 2019; 13: 541-554
• 16 Reich K, Leonardi C, Langley RG. et al. Inflammatory bowel disease among patients with psoriasis treated with ixekizumab: A presentation of adjudicated data from an integrated database of 7 randomized controlled and uncontrolled trials. Journal of the American Academy of Dermatology 2017; 76: 441-448.e2
• 17 Vavricka SR, Schoepfer A, Scharl M. et al. Extraintestinal Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis 2015; 21: 1982-1992
• 18 Rudwaleit M, Heijde van der D, Landewe R. et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Annals of the Rheumatic Diseases 2009; 68: 777-783
• 19 Karreman MC, Luime JJ, Hazes JMW. et al. The Prevalence and Incidence of Axial and Peripheral Spondyloarthritis in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Journal of Crohn’s and Colitis 2017; 11: 631-642
• 20 Harbord M, Annese V, Vavricka SR. et al. The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease. Journal of Crohn’s and Colitis 2016; 10: 239-254
• 21 Torres J, Bonovas S, Doherty G. et al. ECCO Guidelines on Therapeutics in Crohn’s Disease: Medical Treatment. Journal of Crohn’s and Colitis 2020; 14: 4-22
• 22 S3-Leitlinie Colitis ulcerosa – Living Guideline: Überprüfung 2021. Z Gastroenterol 2021; 59: 479-479
• 23 Lerner A, Matthias T. Rheumatoid arthritis – celiac disease relationship: Joints get that gut feeling. Autoimmunity Reviews 2015; 14: 1038-1047
• 24 Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013; 382: 769-779
• 25 Kearney PM, Baigent C, Godwin J. et al. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ 2006; 332: 1302-1308
• 26 Mukherjee D. Risk of Cardiovascular Events Associated With Selective COX-2 Inhibitors. JAMA 2001; 286: 954
• 27 Laine L, Harper S, Simon T. et al. A randomized trial comparing the effect of rofecoxib, a cyclooxygenase 2 – specific inhibitor, with that of ibuprofen on the gastroduodenal mucosa of patients with osteoarthritis. Gastroenterology 1999; 117: 776-783
• 28 Emery P, Zeidler H, Kvien TK. et al. Celecoxib versus diclofenac in long-term management of rheumatoid arthritis: randomised double-blind comparison. The Lancet 1999; 354: 2106-2111
• 29 Gastrointestinal Toxicity With Celecoxib vs Nonsteroidal Anti-inflammatory Drugs for Osteoarthritis and Rheumatoid Arthritis: The CLASS Study: A Randomized Controlled Trial Clinical Pharmacy and Pharmacology | JAMA | JAMA Network. . Im Internet: https://jamanetwork.com/journals/jama/fullarticle/193062
• 30 Chan FKL, Hung LCT, Suen BY. et al. Celecoxib versus Diclofenac and Omeprazole in Reducing the Risk of Recurrent Ulcer Bleeding in Patients with Arthritis. New England Journal of Medicine 2002; 347: 2104-2110
• 31 Liu D, Ahmet A, Ward L. et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy, Asthma & Clinical Immunology 2013; 9: 30
• 32 Yeomans ND, Graham DY, Husni ME. et al. Randomised clinical trial: gastrointestinal events in arthritis patients treated with celecoxib, ibuprofen or naproxen in the PRECISION trial. Alimentary Pharmacology & Therapeutics 2018; 47: 1453-1463
• 33 Sadr-Azodi O, Mattsson F, Bexlius TS. et al. Association of oral glucocorticoid use with an increased risk of acute pancreatitis: a population-based nested case-control study. JAMA Intern Med 2013; 173: 444-449
• 34 Pappas PG, Kauffman CA, Andes DR. et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2016; 62: e1-e50
• 35 Systematic review and meta-analysis of the efficacy and safety of leflunomide and methotrexate in the treatment of rheumatoid arthritis. Im Internet: https://www.reumatologiaclinica.org/es-pdf-S1699258X17301961
• 36 Korzenik J, Larsen MD, Nielsen J. et al. Increased risk of developing Crohn’s disease or ulcerative colitis in 17 018 patients while under treatment with anti-TNFα agents, particularly etanercept, for autoimmune diseases other than inflammatory bowel disease. Alimentary Pharmacology & Therapeutics 2019; 50: 289-294
• 37 McGeachy MJ, Cua DJ, Gaffen SL. The IL-17 Family of Cytokines in Health and Disease. Immunity 2019; 50: 892-906
• 38 Ärzteblatt DÄG Redaktion Deutsches. Arzneimittelkommission der deutschen Ärzteschaft: „Aus der UAW-Datenbank“ Induktion und/oder Demaskierung von chronisch-entzündlichen Darmerkrankungen… Deutsches Ärzteblatt 2018. Im Internet: https://www.aerzteblatt.de/archiv/197301/Arzneimittelkommission-der-deutschen-Aerzteschaft-Aus-der-UAW-Datenbank-Induktion-und-oder-Demaskierung-von-chronisch-entzuendlichen-Darmerkrankungen-unter-Secukinumab-(Cosentyx-)-Literatur; Stand: 06.06.2021
• 39 Fauny M, Moulin D, D’Amico F. et al. Paradoxical gastrointestinal effects of interleukin-17 blockers. Annals of the Rheumatic Diseases 2020; 79: 1132-1138
• 40 McCarthy EM, Sutton E, Nesbit S. et al. Short-term efficacy and safety of rituximab therapy in refractory systemic lupus erythematosus: results from the British Isles Lupus Assessment Group Biologics Register. Rheumatology (Oxford) 2018; 57: 470-479
• 41 Barbulescu A, Delcoigne B, Askling J. et al. Gastrointestinal perforations in patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs in Sweden: a nationwide cohort study. RMD Open 2020; 6(2) e001201
• 42 Xie F, Yun H, Bernatsky S. et al. Brief Report: Risk of Gastrointestinal Perforation Among Rheumatoid Arthritis Patients Receiving Tofacitinib, Tocilizumab, or Other Biologic Treatments. Arthritis & Rheumatology 2016; 68: 2612-2617
• 43 Robertson KD, Nagra N, Mehta D. Esophageal Candidiasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2021 Im Internet: http://www.ncbi.nlm.nih.gov/books/NBK537268/
• 44 Horvath KD, Whelan RL. Intestinal Tuberculosis: Return of an Old Disease. Official journal of the American College of Gastroenterology | ACG 1998; 93: 692-696
• 45 Kedia S, Das P, Madhusudhan KS. et al. Differentiating Crohn’s disease from intestinal tuberculosis. WJG 2019; 25: 418-432
• 46 Sandgren KE, Price NB, Bishop WP. et al. Herpes Simplex Proctitis Mimicking Inflammatory Bowel Disease in a Teenaged Male. Case Reports in Pediatrics 2017; 2017: e3547230
• 47 You DM, Johnson MD. Cytomegalovirus Infection and the Gastrointestinal Tract. Curr Gastroenterol Rep 2012; 14: 334-342