Mielants H, Veys E M, Cuvelier C, De Vos M, Goemaere S, De Clercq L, Schatteman L, Elewaut D
Department of Rheumatology, Ghent University Hospital, Belgium.
J Rheumatol. 1995 Dec;22(12):2273-8.
To study prospectively the clinical evolution of different forms of spondyloarthropathy (SpA) in relation to the type of gut histology in ileocolonoscopic biopsy specimens.
Ileocolonoscopy was performed in 217 patients with SpA (149 men, 68 women). Three types of gut histology (normal gut histology and acute and chronic inflammatory gut lesions) were found. Clinical, laboratory, and radiological examinations were performed at start and 2 to 9 years later in 123 patients who were regularly monitored. For the remaining 94 patients clinical data were obtained by telephone.
Of the 123 patients monitored regularly, 40 (32%) had normal gut histology, and 28 (23%) had acute and 55 (45%) chronic inflammatory gut lesions. Acute lesions were preferentially found in patients with non-ankylosing spondylitis SpA (non-AS-SpA). In the groups with normal gut histology and with chronic gut inflammation, patients with ankylosing spondylitis (AS) and non-AS-SpA were present in equal numbers. At review, clinical evolution was identical in the 3 histological subgroups. Eight patients developed idiopathic inflammatory bowel disease (IBD), one with initially acute gut inflammation, 7 with initially chronic gut inflammation. All had active AS at review. Fourteen patients with non-AS-SpA developed AS; 13 of them had initially presented inflammatory gut lesions. Three patients in the telephone group also developed IBD; all had active AS at review and initially presented chronic inflammatory gut lesions. Persistently high inflammatory serum variables, HLA-B27 negativity in the presence of sacroiliitis or AS, and inflammatory gut lesions at the first ileocolonoscopy indicate patients with SpA are at risk for developing IBD.
Gut inflammation, mainly subclinical, could be demonstrated in 68% of patients with SpA. Acute gut inflammation was predominant in patients with reactive arthritis (ReA). The evolution to clinical remission was not influenced by the presence or the type of gut inflammation at start. Patients with non-AS-SpA with inflammatory gut lesions have greater risk of developing AS. One patient with Yersinia induced ReA developed AS and IBD. In total, 11 patients (66%) developed IBD, all initially presenting inflammatory gut lesions. Ten had chronic gut lesions, suggesting this type of gut inflammation is related to the inflammation of Crohn's disease. This type of gut inflammation, the persistence of high inflammatory serum variables, and the absence of HLA-B27 in patients with AS are risk factors for developing IBD.
前瞻性研究不同类型脊柱关节炎（SpA）的临床演变与回结肠活检标本中肠道组织学类型的关系。
对217例SpA患者（149例男性，68例女性）进行回结肠镜检查。发现三种肠道组织学类型（正常肠道组织学以及急性和慢性炎症性肠道病变）。对123例接受定期监测的患者在开始时以及2至9年后进行了临床、实验室和放射学检查。对于其余94例患者，通过电话获取临床数据。
在123例接受定期监测的患者中，40例（32%）肠道组织学正常，28例（23%）有急性炎症性肠道病变，55例（45%）有慢性炎症性肠道病变。急性病变在非强直性脊柱炎SpA（非AS-SpA）患者中更为常见。在肠道组织学正常和慢性肠道炎症组中，强直性脊柱炎（AS）和非AS-SpA患者数量相等。复查时，三个组织学亚组的临床演变相同。8例患者发展为特发性炎症性肠病（IBD），1例最初有急性肠道炎症，7例最初有慢性肠道炎症。复查时所有患者均有活动性AS。14例非AS-SpA患者发展为AS；其中13例最初有炎症性肠道病变。电话组中的3例患者也发展为IBD；复查时均有活动性AS，最初均有慢性炎症性肠道病变。炎症血清变量持续升高、骶髂关节炎或AS患者中HLA-B27阴性以及首次回结肠镜检查时有炎症性肠道病变表明SpA患者有发展为IBD的风险。
68%的SpA患者可出现肠道炎症，主要为亚临床炎症。急性肠道炎症在反应性关节炎（ReA）患者中占主导。开始时肠道炎症的存在或类型不影响临床缓解的演变。有炎症性肠道病变的非AS-SpA患者发展为AS的风险更高。1例耶尔森菌诱发的ReA患者发展为AS和IBD。共有11例患者（66%）发展为IBD，均最初有炎症性肠道病变。10例有慢性肠道病变，提示这种肠道炎症类型与克罗恩病的炎症有关。这种肠道炎症类型、炎症血清变量持续升高以及AS患者中HLA-B27缺失是发展为IBD的危险因素。
