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Intestinal pseudo-obstruction in systemic lupus erythematosus
J Narváez1, C Pérez-Vega, F J Castro-Bohorquez
1Rheumatology Unit, Clínica Delfos, Barcelona, Spain. 31577edd@comb.es
Scandinavian Journal of Rheumatology
|August 2, 2003
Summary
Systemic lupus erythematosus (SLE) can manifest as intestinal pseudo-obstruction (IPO). Early recognition and high-dose steroids are key for managing this SLE complication, which may present initially.
Area of Science:
- Gastroenterology
- Rheumatology
- Internal Medicine
Background:
- Systemic lupus erythematosus (SLE) is a complex autoimmune disease with diverse clinical manifestations.
- Intestinal pseudo-obstruction (IPO) is a rare but increasingly recognized gastrointestinal complication of SLE.
Observation:
- This study documents IPO as a manifestation of SLE through a case report and literature review of 21 additional cases.
- In 41% of cases, IPO was the initial presenting symptom of underlying SLE.
- IPO in SLE patients showed clinical and laboratory features similar to general SLE cohorts, with a notable association with urinary tract involvement (ureterohydronephrosis, interstitial cystitis).
Findings:
- The pathogenic mechanisms underlying IPO in SLE appear heterogeneous and are not fully elucidated.
- IPO demonstrated a prompt response to high-dose steroid therapy across all reported cases.
- In some instances, IPO progression occurred independently of overall SLE disease activity.
Implications:
- Increased clinical awareness of IPO as a potential SLE manifestation is crucial to prevent misdiagnosis and unnecessary surgical interventions.
- Prompt diagnosis and appropriate immunosuppressive therapy, particularly high-dose steroids, are vital for managing IPO in SLE patients.
- Further research into the heterogeneous pathogenic mechanisms of IPO in SLE may reveal targeted therapeutic strategies.