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Crohn's disease associated with seropositive rheumatoid arthritis
1Department of Rheumatology, University Hospital J. Minjoz, Besançon, France.
Insights
This study presents two rheumatoid arthritis (RA) cases linked with Crohn's disease (CD). The findings highlight the complex relationship between these autoimmune conditions and their potential co-occurrence.
Area of Science:
- Rheumatology
- Gastroenterology
- Immunology
Background:
- Rheumatoid arthritis (RA) and Crohn's disease (CD) are chronic autoimmune disorders.
- The co-occurrence of RA and CD is rare, necessitating further investigation into their potential links.
- Understanding the interplay between these conditions is crucial for accurate diagnosis and effective management.
Observation:
- Two distinct cases illustrate the association between RA and CD.
- Case 1: A male patient with established CD developed seropositive, nodular RA with sacroiliitis.
- Case 2: A female patient with a history of seropositive RA was secondarily diagnosed with CD.
Findings:
- Both patients shared the DR1 (DRB1* 0101) human leukocyte antigen.
- Gastrointestinal involvement in RA can manifest diversely, including drug-induced issues, vasculitis, amyloidosis, and associated bowel diseases.
- Differentiating between RA and enteropathic arthritis can be challenging due to overlapping symptoms like erosive polyarthritis and gastrointestinal issues.
Implications:
- The findings suggest that the coexistence of inflammatory bowel disease and RA may occur by chance, given their low individual occurrence.
- Further research is warranted to elucidate the underlying mechanisms connecting RA and CD.
- Recognizing this association can aid clinicians in the differential diagnosis and treatment of patients presenting with overlapping symptoms.
Abstract:
We report two cases of rheumatoid arthritis (RA) associated with Crohn's disease (CD). The first case was a 60-year-old man with longstanding CD who next developed a seropositive, nodular RA. This patient also had bilateral sacroiliitis, but without positive HLA B27. The second was a 65-year-old female with a 15-year history of seropositive RA who presented secondarily a CD. No sacroiliitis or nodules were found in this patient. Both patients were DR1 (DRB1* 0101). Gold salts were only given in the second case and were stopped many years before the gastrointestinal symptoms. A similar case report has been previously described consisting in an ulcerative colitis complicating a seronegative HLA-B27 RA with sacroiliitis. The gastrointestinal involvement in RA may be broad and includes many causes: drug-induced colitis (including gold enterocolitis) vasculitis and amyloidosis located in the gut, associated bowel disease such as collagenous colitis, and also infectious agents. In addition, erosive polyarthritis associated with gastrointestinal manifestations can present a problem in the differential diagnosis between RA and an enteropathic arthritis. Finally, the coexistence by chance of inflammatory bowel disease and RA is suggested by the low occurrence of these two conditions in the same patient.