Mielants H, Veys E M, Cuvelier C, De Vos M, Goemaere S, De Clercq L, Schatteman L, Gyselbrecht L, Elewaut D
Department of Rheumatology, Ghent University Hospital, Belgium.
J Rheumatol. 1995 Dec;22(12):2279-84.
To study prospectively the clinical evolution of different forms of spondyloarthropathy (SpA) in relation to the evolution of gut histology in consecutive ileocolonoscopic biopsy specimens.
Ileocolonoscopy was performed in 49 patients with SpA (34 men, 15 women). They also underwent clinical, laboratory, and radiological examinations. Two to 9 years later, a 2nd and sometimes a 3rd or 4th ileocolonoscopy was performed, and the other examinations were repeated.
At first ileocolonoscopy, 34 patients (69%) showed inflammatory gut lesions. At the 2nd ileocolonoscopy, 16 patients (32%) were in clinical remission; none were found to have inflammatory gut lesions. Of the 33 patients with persistent locomotor inflammation, 14 had persistent inflammatory gut lesions, predominantly the chronic type. Of these 14 patients, 6 had developed inflammatory bowel disease (IBD). None of the 15 patients with an initially normal gut histology had gut inflammation at 2nd examination. Of the 9 with initially acute lesions, 3 developed chronic lesions (1 Crohn's disease). Initial chronic lesions in 25 patients persisted in 9, of whom 5 had developed IBD. Seven of the 19 patients with non-SpA ankylosing spondylitis (non-AS-SpA) developed ankylosing spondylitis (AS); all had initially presented inflammatory gut lesions, which persisted at 2nd examination. In the 11 patients with more than 2 consecutive ileocolonoscopies, clinical remission was always associated with normal gut histology, and flares of the joint disease were related temporally to the reappearance of gut inflammation.
This study demonstrates the close relationship between gut and locomotor inflammation in SpA. Clinical remission was always associated with normal gut histology, whereas active locomotor inflammation was usually associated with the presence of gut inflammation. Absence of gut inflammation in the SpA is a good prognostic indicator, since gut inflammation or IBD never develops in these patients. Evolution of non-AS-SpA to full blown AS or of uncomplicated SpA to a form of IBD was always associated with gut inflammation at disease onset.
前瞻性研究不同形式的脊柱关节炎（SpA）的临床演变与连续回结肠镜活检标本中肠道组织学演变的关系。
对49例SpA患者（34例男性，15例女性）进行回结肠镜检查。他们还接受了临床、实验室和放射学检查。2至9年后，进行第二次回结肠镜检查，有时还进行第三次或第四次检查，并重复其他检查。
在首次回结肠镜检查时，34例患者（69%）出现肠道炎症性病变。在第二次回结肠镜检查时，16例患者（32%）处于临床缓解期；未发现有肠道炎症性病变。在33例持续性运动性炎症患者中，14例有持续性肠道炎症性病变，主要为慢性类型。在这14例患者中，6例发展为炎症性肠病（IBD）。15例最初肠道组织学正常的患者在第二次检查时均无肠道炎症。在9例最初为急性病变的患者中，3例发展为慢性病变（1例克罗恩病）。25例最初为慢性病变的患者中有9例持续存在，其中5例发展为IBD。19例非SpA强直性脊柱炎（非AS-SpA）患者中有7例发展为强直性脊柱炎（AS）；所有患者最初均有肠道炎症性病变，在第二次检查时仍持续存在。在11例连续进行2次以上回结肠镜检查的患者中，临床缓解总是与肠道组织学正常相关，关节疾病的发作在时间上与肠道炎症的再次出现有关。
本研究表明SpA中肠道和运动性炎症之间存在密切关系。临床缓解总是与肠道组织学正常相关，而活跃的运动性炎症通常与肠道炎症的存在相关。SpA患者无肠道炎症是一个良好的预后指标，因为这些患者从不发展为肠道炎症或IBD。非AS-SpA发展为完全性AS或单纯SpA发展为IBD的形式总是与疾病发作时的肠道炎症相关。
