Parra Izquierdo Viviana, Chumacero Katherin, Alvarado Julio, Buenahora Maria, Monsalve Monica, Torres Ana, Chila Moreno Lorena, Florez Cristian, Ramos Casallas Alejandro, De Avila Juliette, Bello Juan, Jaimes Diego, Pacheco Tena Cesar, Bautista Molano Wilson, Romero-Sanchez Consuelo
Hospital Internacional de Colombia, BUCARAMANGA, Colombia.
Universidad El Bosque, Bogota, Colombia.
Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S13. doi: 10.14309/01.ajg.0000798800.50422.bc.
Spondyloarthritis (SpA) is a heterogeneous group of chronic autoinflammatory disorders that can present extra-articular gastrointestinal manifestations. Among them is mainly inflammatory bowel disease (IBD). Although IBD mainly affects the intestinal tract, it can include early manifestations evident in the oral cavity. No comparative data on these oral manifestations in patients with SpA were found in the literature.
To identify oral clinical manifestations due to changes in the oral mucosa associated with IBD in patients with SpA without a diagnosis of IBD and associate them with endoscopic and histological findings.
80 patients with SpA and 52 healthy controls were evaluated. They were assessed intra- and extra-orally, following the modified World Health Organization guideline. In addition, by clinical parameters of rheumatological, gastrointestinal and laboratory activity. Ileocolonoscopy was performed with digital chromoendoscopy with magnification and histological analysis. Comparative analyzes were performed by Chi square tests, Fisher's exact tests, confirmed by univariate regression and discriminant analysis of multiple correspondences. Institutional ethics committee approval cod-2017-023.
The patients with SpA had 56% male gender, mean age of 42.8 years (SD ± 10.4) and a BMI in the range of 23.9 - 28.4. The healthy controls, 54% of the male gender with an average age of 41 years (SD ± 13.6) and a body mass index-BMI in the range of 22.9 - 27.6. The patients reported smoking only in 6.2%, however as a smoking history in 31% and passive smokers (15%), the majority employed (41%), married (56%) and professionals (49%). Of the healthy controls, they smoked (15%), with a history of smoking (31%), passive smokers (21%), the majority employed (77%), with their own home (67%), and professionals (54%). The patients with SpA reported a greater presence of some signs and symptoms of gastrointestinal origin 69%, while in the controls it was 7.7% (p = 0.001). Forty one of them were referred to colonoscopy with magnification being in 17.1 % changes in the mucosa of the rectum and in the same frequency changes in the mucosa of the sigmoid colon. Regarding the ileum, changes in the mucosa were evidenced in 41.5% of the cases. The presence of oral lesions was evident and predominated in them (63%) compared to controls p = 0.050. The main oral lesions associated with IBD were gingivitis (55%) (p = 0.001), followed by aphthous stomatitis (3.8%), angular cheilitis (2.6%) and perioral erythema with scaling (1.3%). 100% of the patients who presented alteration of the colonic mucosa presented oral lesions associated with IBD (p = 0039), which was also significantly associated with the presence of gingivitis/aphthous stomatitis (p = 0.029).
Patients with SpA without a diagnosis of IBD have more oral signs and symptoms compared to healthy controls. Gingivitis is important given its association with early endoscopic and histological findings. Manifestations in the oral cavity can precede intestinal manifestations, therefore the clinical assessment by the oral pathologist in conjunction with gastroenterology and rheumatology allows a timely referral to gastroenterology and an endoscopic and histological evaluation, impacting the quality of life of patients.
脊柱关节炎（SpA）是一组异质性慢性自身炎症性疾病，可出现关节外胃肠道表现。其中主要是炎症性肠病（IBD）。虽然IBD主要影响肠道，但它可能包括口腔中明显的早期表现。文献中未发现关于SpA患者这些口腔表现的比较数据。
确定未诊断为IBD的SpA患者中与IBD相关的口腔黏膜变化所致的口腔临床表现，并将其与内镜和组织学检查结果相关联。
对80例SpA患者和52例健康对照进行评估。按照修改后的世界卫生组织指南对他们进行口腔内和口腔外评估。此外，还评估了风湿病学、胃肠道和实验室活动的临床参数。采用带放大功能的数字染色内镜进行回结肠镜检查并进行组织学分析。通过卡方检验、Fisher精确检验进行比较分析，并通过单变量回归和多重对应判别分析进行验证。获得机构伦理委员会批准，批准号为2017 - 023。
SpA患者中男性占56%，平均年龄42.8岁（标准差±10.4），体重指数（BMI）在23.9 - 28.4之间。健康对照中，男性占54%，平均年龄41岁（标准差±13.6），体重指数（BMI）在22.9 - 27.6之间。患者中仅6.2%有吸烟行为，然而有吸烟史的占31%，被动吸烟者占15%，大多数为在职人员（41%）、已婚（56%）和专业人员（49%）。健康对照中，吸烟者占15%，有吸烟史的占31%，被动吸烟者占21%，大多数为在职人员（77%），有自有住房（67%），专业人员占54%。SpA患者中报告有更多胃肠道源性体征和症状的占69%，而对照组为7.7%（p = 0.001）。其中41例接受了放大结肠镜检查，直肠黏膜改变占17.1%，乙状结肠黏膜改变频率相同。关于回肠，41.5%的病例有黏膜改变。与对照组相比，口腔病变在患者中明显且占主导（63%），p = 0.050。与IBD相关的主要口腔病变为牙龈炎（55%）（p = 0.001），其次为阿弗他口炎（3.8%）、口角炎（2.6%）和口周红斑伴脱屑（1.3%）。结肠黏膜有改变的患者中100%有与IBD相关的口腔病变（p = 0.039），这也与牙龈炎/阿弗他口炎的存在显著相关（p = 0.029）。
未诊断为IBD的SpA患者比健康对照有更多的口腔体征和症状。鉴于牙龈炎与早期内镜和组织学检查结果相关，其较为重要。口腔表现可能先于肠道表现出现，因此口腔病理学家与胃肠病学和风湿病学专家联合进行临床评估可实现及时转诊至胃肠病学专家处并进行内镜和组织学评估，从而影响患者的生活质量。
