Bjarnason I, Williams P, So A, Zanelli G D, Levi A J, Gumpel J M, Peters T J, Ansell B
Lancet. 1984 Nov 24;2(8413):1171-4. doi: 10.1016/s0140-6736(84)92739-9.
The suggestion that the intestinal mucosa may be abnormally permeable and a site of absorption of antigens in rheumatoid arthritis was tested by the use of a 51Cr-EDTA (edetic acid) absorption test. 24 patients with rheumatoid arthritis excreted significantly more 51Cr-EDTA than did 34 controls. Intestinal permeability was normal in untreated patients but almost invariably abnormal in patients treated with non-steroidal anti-inflammatory drugs. Studies in patients with osteoarthritis showed that the permeability abnormalities were due to an effect of NSAIDs on both the proximal and the distal intestine and that the effect was systemically mediated. Indium-111-labelled leucocyte scans showed ileocaecal inflammation in 6 of 9 patients on or recently on NSAIDs. Although increased intestinal permeability does not seem to be important in the pathogenesis of rheumatoid arthritis, the administration of NSAIDs may lead to loss of intestinal integrity, thus facilitating antigenic absorption and perhaps contributing to persistence of the disease.
通过使用51铬-乙二胺四乙酸（EDTA）吸收试验，对肠道黏膜可能异常通透且是类风湿性关节炎抗原吸收部位这一假说进行了检验。24例类风湿性关节炎患者排泄的51铬-EDTA明显多于34例对照者。未经治疗的患者肠道通透性正常，但使用非甾体抗炎药治疗的患者几乎无一例外存在异常。对骨关节炎患者的研究表明，通透性异常是由于非甾体抗炎药对近端和远端肠道均有影响，且这种影响是由全身介导的。铟-111标记的白细胞扫描显示，9例正在服用或近期服用非甾体抗炎药的患者中有6例存在回盲部炎症。尽管肠道通透性增加在类风湿性关节炎发病机制中似乎并不重要，但使用非甾体抗炎药可能导致肠道完整性丧失，从而促进抗原吸收，可能导致疾病持续存在。
