1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Medical School, University of Ioannina, Ioannina 45110, Greece.
J Crohns Colitis. 2012 Aug;6(7):735-42. doi: 10.1016/j.crohns.2012.03.005. Epub 2012 Apr 14.
Coexistence of systemic lupus erythematosus (SLE) should be considered in patients with inflammatory bowel disease (IBD) and complex extraintestinal manifestations and the diagnosis of IBD could be established either before or after the diagnosis of SLE. Differential diagnosis of concomitant SLE and IBD is difficult and should always exclude infectious conditions, lupus-like reactions, visceral vasculitis and drug-induced lupus. The underlying mechanism by which 5-ASA/sulphasalazine induces SLE or lupus-like syndromes is not clear and high awareness for possible predictive factors is demanded for early prevention. In most cases the symptoms from drug-induced lupus have been reversible after the discontinuation of the drug and response to steroids is favorable. Treatment of patients co-diagnosed with SLE and IBD may include corticosteroids, immunosupressants and hydroxychloroquine. In severe lupus and IBD patients cyclophosphamide pulse may be of benefit while infliximab may be beneficiary in patients with lupus nephritis. However, the role TNFalpha plays in humans with SLE and IBD is controversial and data on the likely effects of blocking TNFalpha on anti-DNA autoantibody production is always of interest.
红斑狼疮（SLE）与炎症性肠病（IBD）并存应考虑在患者具有复杂的肠外表现和 IBD 的诊断可以建立之前或之后的 SLE 的诊断。同时存在的 SLE 和 IBD 的鉴别诊断困难，应始终排除感染条件、狼疮样反应、内脏血管炎和药物诱导的狼疮。5-ASA/柳氮磺胺吡啶诱导 SLE 或狼疮样综合征的潜在机制尚不清楚，需要高度认识可能的预测因素，以便早期预防。在大多数情况下，药物诱导的狼疮的症状在停药后已经可逆，对类固醇的反应是有利的。SLE 和 IBD 合并诊断的患者的治疗可能包括皮质类固醇、免疫抑制剂和羟氯喹。在严重的狼疮和 IBD 患者环磷酰胺脉冲可能是有益的，而 infliximab 可能在狼疮肾炎患者中受益。然而，TNFalpha 在人类 SLE 和 IBD 中的作用是有争议的，关于阻断 TNFalpha 对抗 DNA 自身抗体产生的可能影响的数据总是很有趣。
