What types of arthritis can be associated with carcinomas of the esophagus and colon? Carcinomatous polyarthritis can be the presenting feature of an occult malignancy of the GI tract. The arthritis is typically acute in onset and asymmetric and predominantly involves lower extremity joints while sparing the small joints of the hands and wrists. Patients …
Arthritis with carcinomas of the esophagus and colon Read More »
Intestinal bypass arthritis dermatitis syndrome In the past, this syndrome occurred in 20% to 80% of patients who had undergone intestinal bypass (jejunoileal or jejunocolic) surgery for morbid obesity. With newer techniques for bariatric surgery, this has been eliminated. Currently this is a rare complication occurring in GI diseases with defective peristalsis (systemic sclerosis, colorectal …
What rheumatic manifestations have been described in patients with celiac disease (CeD; gluten sensitive enteropathy)? CeD is an enteropathy resulting from an autoimmune reaction to wheat gluten and gliadin by T lymphocytes in the gut in genetically predisposed individuals. It is primarily seen in white patients and is associated with HLA-DQ2 or HLA-DQ8, usually in linkage with HLA-DR3 . Tissue transglutaminase …
How is Whipple disease best treated? Initial treatment is ceftriaxone (or meropenem) for 2 weeks to ensure therapy of the CNS. Oral trimethoprim (TMP)–sulfamethoxazole (SMX) is subsequently used for more than 1 year. Tetracycline can be used in sulfa-allergic patients. Relapses can occur particularly in patients with CNS involvement (30%). These patients should be treated …
What causes Whipple disease and how is the diagnosis made? Whipple disease is caused by a gram-positive actinomycete called Tropheryma whipplei. The diagnosis is made by demonstrating periodic acid–Schiff (PAS)-positive inclusions in macrophages of affected tissues, typically a small bowel or lymph node biopsy sample. These deposits contain the rod-shaped free Tropheryma whipplei bacilli seen on electron microscopy. …
Clinical characteristics of the arthritis associated with Whipple disease Whipple disease occurs most commonly in middle-aged white men (male/female ratio, 8:1). Seronegative oligoarthritis or polyarthritis (knees, ankles, wrists) is the presenting symptom in 60% of patients and may precede the intestinal symptoms by up to 5 years. More than 70% of patients will develop arthritis …
Is any therapy beneficial for postenteritic reactive arthritis? Treatment of Postenteritic Reactive Arthritis Treatment Acute Chronic Sacroiliitis NSAIDs Yes Yes Yes CorticosteroidsIntraarticularOral only if used in high doses YesNo YesNo Yes Antibiotics2-wk course3-mo course NoNA NoNo NoNo Sulfasalazine NA Yes No Methotrexate NA Yes No Anti-TNFα * NA Yes Yes NA, Not applicable; NSAID, nonsteroidal antiinflammatory drug; TNF, tumor necrosis factor. …